title: Forecasting the morbidity and mortality associated with prevalent cases of pre-cirrhotic chronic hepatitis C in the United States.
abstract: BACKGROUND
  Without diagnosis and antiviral therapy, many patients with chronic hepatitis C infections will develop end-stage liver disease and die from complications.
  
  
  OBJECTIVE
  To evaluate the future impacts of preventive interventions and treatment advances, this paper forecasts a baseline estimate of the future morbidity and mortality of prevalent hepatitis C when left untreated.
  
  
  METHODS
  We simulated the future disease progression and death for all Americans with prevalent hepatitis C in 2005. To validate the model, we used past seroprevalence to forecast contemporary outcomes. We used the validated model to forecast future cases of end-stage liver disease, transplants, and deaths from 2010 to 2060, and we estimated credible intervals using Monte Carlo simulation.
  
  
  RESULTS
  When programmed with past data, our model predicted current levels of hepatitis C outcomes with accuracy between ±1% and 13%. Morbidity and mortality from hepatitis C will rise from 2010 to a peak between the years 2030 and 2035. We forecasted a peak of 38,600 incident cases of end-stage liver disease; 3200 referrals for transplant; and 36,100 deaths.
  
  
  CONCLUSIONS
  Because current rates of screening and treatment are low, future morbidity and mortality from hepatitis C are likely to increase substantially without public health interventions to increase treatment.
authors.affiliation: RTI International, Atlanta, GA, United States. drein@rti.org
authors.forename: David B
authors.initials: DB
authors.lastname: Rein
authors.forename: John S
authors.initials: JS
authors.lastname: Wittenborn
authors.forename: Cindy M
authors.initials: CM
authors.lastname: Weinbaum
authors.forename: Miriam
authors.initials: M
authors.lastname: Sabin
authors.forename: Bryce D
authors.initials: BD
authors.lastname: Smith
authors.forename: Sarah B
authors.initials: SB
authors.lastname: Lesesne
mesh_terms: D000328:Adult; D058345:Asymptomatic Infections / Q000453:epidemiology* / Q000401:mortality; D003198:Computer Simulation; D018450:Disease Progression; D058625:End Stage Liver Disease / Q000453:epidemiology* / Q000401:mortality; D005260:Female; D005544:Forecasting; D019698:Hepatitis C, Chronic / Q000453:epidemiology* / Q000401:mortality; D006801:Humans; D016031:Liver Transplantation / Q000639:trends*; D008297:Male; D008390:Markov Chains; D008875:Middle Aged; D008962:Models, Theoretical; D009010:Monte Carlo Method; D009017:Morbidity / Q000639:trends; D014481:United States / Q000453:epidemiology; D055815:Young Adult