Increased uptake and new therapies are needed to avert rising hepatitis C-related end stage liver disease in England: modelling the predicted impact of treatment under different scenarios.
OBJECTIVE
Hepatitis C (HCV) related disease in England is predicted to rise, and it is unclear whether treatment at current levels will be able to avert this. The aim of this study was to estimate the number of people with chronic HCV infection in England that are treated and assess the impact and costs of increasing treatment uptake.


METHODS
Numbers treated were estimated using national data sources for pegylated interferon supplied, dispensed, or purchased from 2006 to 2011. A back-calculation approach was used to project disease burden over the next 30 years and determine outcomes under various scenarios of treatment uptake.


RESULTS
5000 patients were estimated to have been treated in 2011 and 28,000 in total from 2006 to 2011; approximately 3.1% and 17% respectively of estimated chronic infections. Without treatment, incident cases of decompensated cirrhosis and hepatocellular carcinoma were predicted to increase until 2035 and reach 2290 cases per year. Treatment at current levels should reduce incidence by 600 cases per year, with a peak around 2030. Large increases in treatment are needed to halt the rise; and with more effective treatment the best case scenario predicts incidence of around 500 cases in 2030, although treatment uptake must still be increased considerably to achieve this.


CONCLUSIONS
If the infected population is left untreated, the number of patients with severe HCV-related disease will continue to increase and represent a substantial future burden on healthcare resources. This can be mitigated by increasing treatment uptake, which will have the greatest impact if implemented quickly.
Statistics, Modelling and Bioinformatics Department, Centre for Infectious Disease Surveillance and Control, Public Health England, 61 Colindale Avenue, London NW9 5EQ, United Kingdom.
Ross J
RJ
Harris
Immunisation, Hepatitis and Blood Safety Department, Centre for Infectious Disease Surveillance and Control, Public Health England, 61 Colindale Avenue, London NW9 5EQ, United Kingdom.
Brenda
B
Thomas
Immunisation, Hepatitis and Blood Safety Department, Centre for Infectious Disease Surveillance and Control, Public Health England, 61 Colindale Avenue, London NW9 5EQ, United Kingdom.
Jade
J
Griffiths
Immunisation, Hepatitis and Blood Safety Department, Centre for Infectious Disease Surveillance and Control, Public Health England, 61 Colindale Avenue, London NW9 5EQ, United Kingdom.
Annastella
A
Costella
United BioSource Corporation, 26-28 Hammersmith Grove, London W6 7HA, United Kingdom.
Ruth
R
Chapman
Immunisation, Hepatitis and Blood Safety Department, Centre for Infectious Disease Surveillance and Control, Public Health England, 61 Colindale Avenue, London NW9 5EQ, United Kingdom.
Mary
M
Ramsay
Statistics, Modelling and Bioinformatics Department, Centre for Infectious Disease Surveillance and Control, Public Health England, 61 Colindale Avenue, London NW9 5EQ, United Kingdom; MRC Biostatistics Unit, Cambridge Institute of Public Health, Forvie Site, Robinson Way, Cambridge Biomedical Campus, Cambridge CB2 0SR, United Kingdom.
Daniela
D
De Angelis
Immunisation, Hepatitis and Blood Safety Department, Centre for Infectious Disease Surveillance and Control, Public Health England, 61 Colindale Avenue, London NW9 5EQ, United Kingdom. Electronic address: helen.harris@phe.org.uk.
Helen E
HE
Harris
D000328:Adult; D000998:Antiviral Agents / Q000191:economics* / Q000627:therapeutic use*; D006528:Carcinoma, Hepatocellular / Q000453:epidemiology / Q000517:prevention & control; D017281:Cost of Illness; D058625:End Stage Liver Disease / Q000191:economics / Q000453:epidemiology* / Q000517:prevention & control*; D004739:England / Q000453:epidemiology; D017048:Health Care Costs / Q000639:trends; D019698:Hepatitis C, Chronic / Q000150:complications / Q000188:drug therapy* / Q000191:economics; D006801:Humans; D016898:Interferon-alpha / Q000191:economics / Q000627:therapeutic use; D008103:Liver Cirrhosis / Q000453:epidemiology / Q000517:prevention & control; D008113:Liver Neoplasms / Q000453:epidemiology / Q000517:prevention & control; D008875:Middle Aged; D015233:Models, Statistical; D011092:Polyethylene Glycols / Q000191:economics / Q000627:therapeutic use; D011994:Recombinant Proteins / Q000191:economics / Q000627:therapeutic use; D012189:Retrospective Studies; D012254:Ribavirin / Q000191:economics / Q000627:therapeutic use; D012307:Risk Factors; D016896:Treatment Outcome
D000998:Antiviral Agents; D016898:Interferon-alpha; D011994:Recombinant Proteins; D011092:Polyethylene Glycols; D012254:Ribavirin; C100416:peginterferon alfa-2a
Back-calculation; Disease burden; Hepatitis C; Liver disease; Modelling; Treatment