title: Impact of emerging hepatitis C virus treatments on future needs for liver transplantation in France: a modelling approach.
abstract: BACKGROUND
  In light of the impact of emerging hepatitis C virus treatments on morbidity and mortality, we sought to determine whether candidates for liver transplantation for hepatocellular carcinoma and decompensated cirrhosis will decrease sufficiently to match liver grafts for hepatitis C virus-infected patients.
  
  
  OBJECTIVE
  Using a Markov model, we quantified future liver graft needs for hepatitis C virus-induced diseases and estimated the impact of current and emerging treatments.
  
  
  METHODS
  We simulated progression of yearly-hepatitis-C-virus-infected cohorts from the beginning of the epidemic and calculated 2013-2022 candidates for liver transplantation up until 2022 without and with therapies. We compared these estimated numbers to projected trends in liver grafts for hepatitis C virus.
  
  
  RESULTS
  Overall, current treatment would avoid transplantation of 4425 (4183-4684) potential candidates during the period 2013-2022. It would enable an 88% and 42% reduction in the gap between liver transplantation activity and candidates for hepatocellular carcinoma and decompensated cirrhosis, respectively. Emerging hepatitis C virus treatments would allow adequacy in transplant activities for hepatocellular carcinoma. However, they would not lead to adequacy in decompensated cirrhosis from 2013 to 2022. Results were robust to sensitivity analysis.
  
  
  CONCLUSIONS
  Our study indicates that patients will benefit from public health policies regarding hepatitis C virus screening and therapeutic access to new emerging treatments.
authors.affiliation: Inserm U995, University of Lille Nord de France, Lille, France; Inserm ATIP-AVENIR, Denis Diderot University, Paris, France.
authors.forename: Sylvie
authors.initials: S
authors.lastname: Deuffic-Burban
authors.affiliation: Inserm U995, University of Lille Nord de France, Lille, France; Hepatology Unit, Claude Huriez Hospital, CHRU Lille, Lille, France.
authors.forename: Philippe
authors.initials: P
authors.lastname: Mathurin
authors.affiliation: Intercommunal Hospital, Créteil, France.
authors.forename: Isabelle
authors.initials: I
authors.lastname: Rosa
authors.affiliation: Inserm U866/Digestive Cancer Registry, Faculty of Medicine, Dijon, France; University Hospital, Burgundy University, Dijon, France.
authors.forename: Anne-Marie
authors.initials: AM
authors.lastname: Bouvier
authors.affiliation: Hepatology Unit, Claude Huriez Hospital, CHRU Lille, Lille, France.
authors.forename: Amélie
authors.initials: A
authors.lastname: Cannesson
authors.affiliation: Inserm U995, University of Lille Nord de France, Lille, France; Inserm ATIP-AVENIR, Denis Diderot University, Paris, France.
authors.forename: Abbas
authors.initials: A
authors.lastname: Mourad
authors.affiliation: Hepatology Unit, Claude Huriez Hospital, CHRU Lille, Lille, France.
authors.forename: Valérie
authors.initials: V
authors.lastname: Canva
authors.affiliation: Inserm U995, University of Lille Nord de France, Lille, France; Hepatology Unit, Claude Huriez Hospital, CHRU Lille, Lille, France.
authors.forename: Alexandre
authors.initials: A
authors.lastname: Louvet
authors.affiliation: Hepatology Unit, Claude Huriez Hospital, CHRU Lille, Lille, France; Hepato-Gastroenterology Unit, Jolimont Hospital, Haine-Saint-Paul, Belgium.
authors.forename: Pierre
authors.initials: P
authors.lastname: Deltenre
authors.affiliation: Digestive Surgery and Liver Transplantation Unit, Claude Huriez Hospital, CHRU Lille, Lille, France.
authors.forename: Emmanuel
authors.initials: E
authors.lastname: Boleslawski
authors.affiliation: Digestive Surgery and Liver Transplantation Unit, Claude Huriez Hospital, CHRU Lille, Lille, France.
authors.forename: Stéphanie
authors.initials: S
authors.lastname: Truant
authors.affiliation: Digestive Surgery and Liver Transplantation Unit, Claude Huriez Hospital, CHRU Lille, Lille, France.
authors.forename: François-René
authors.initials: FR
authors.lastname: Pruvot
authors.affiliation: Inserm U995, University of Lille Nord de France, Lille, France; Hepatology Unit, Claude Huriez Hospital, CHRU Lille, Lille, France. Electronic address: sebastien.dharancy@chru-lille.fr.
authors.forename: Sébastien
authors.initials: S
authors.lastname: Dharancy
mesh_terms: D000998:Antiviral Agents / Q000627:therapeutic use*; D006528:Carcinoma, Hepatocellular / Q000209:etiology / Q000601:surgery*; D005602:France; D019698:Hepatitis C, Chronic / Q000150:complications / Q000188:drug therapy*; D006801:Humans; D008103:Liver Cirrhosis / Q000209:etiology / Q000601:surgery*; D008113:Liver Neoplasms / Q000209:etiology / Q000601:surgery*; D016031:Liver Transplantation; D008390:Markov Chains; D009927:Tissue and Organ Procurement; D019737:Transplants / Q000600:supply & distribution*
chemical_list: D000998:Antiviral Agents
keywords: Direct-acting antiviral agents; HCV epidemic; Liver graft allocation; Markov model; Multi-organ procurement