title: Enhanced antiviral treatment efficacy and uptake in preventing the rising burden of hepatitis C-related liver disease and costs in Australia.
abstract: OBJECTIVE
  Chronic hepatitis C virus (HCV) infection is an important cause of advanced liver disease and liver-related deaths in Australia. Our aim was to describe the burden of HCV infection and consider treatment strategies to reduce HCV-related morbidity and mortality.
  
  
  METHODS
  Baseline model parameters were based upon literature review and expert consensus with a focus on Australian data. Three treatment scenarios based on anticipated introduction of improved direct-acting antiviral regimens were considered to reduce HCV disease burden. Scenario 1 evaluated the impact of increased treatment efficacy alone (to 80-90% by 2016). Scenario 2 evaluated increased efficacy and increased treatment uptake (2550 to 13,500 by 2018) without treatment restriction, while Scenario 3 considered the same increases with treatment limited to ≥ F3 during 2015-2017.
  
  
  RESULTS
  In 2013, there were an estimated 233,490 people with chronic HCV infection: 13,850 with cirrhosis, 590 with hepatocellular carcinoma (HCC) and 530 liver-related deaths. If the current HCV treatment setting is unchanged, threefold increases in the number of people with cirrhosis, HCC, and liver disease deaths will be seen by 2030. Scenario 1 resulted in modest impacts on disease burden (4% decrease in HCC, decompensated cirrhosis, and liver deaths) and costs. Scenario 3 had the greatest impact on disease burden (approximately 50% decrease in HCC, decompensated cirrhosis, and liver deaths) and costs, while Scenario 2 had slightly lesser impact.
  
  
  CONCLUSIONS
  Considerable increases in the burden of HCV-related advanced liver disease and its complications will be seen in Australia under current treatment levels and outcomes. Introduction of improved direct-acting antiviral regimens with enhanced efficacy at current treatment levels will lead to limited impacts on this disease burden. A combination of increased treatment efficacy and greater uptake is required to achieve major reductions in advanced liver disease and related costs.
authors: Monash University and Monash Health, Melbourne, Victoria, Australia.
authors: William
authors: W
authors: Sievert
authors: Homie
authors: H
authors: Razavi
authors: Chris
authors: C
authors: Estes
authors: Alexander J
authors: AJ
authors: Thompson
authors: Amany
authors: A
authors: Zekry
authors: Stuart K
authors: SK
authors: Roberts
authors: Gregory J
authors: GJ
authors: Dore
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000998:Antiviral Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D001315:Australia / Q000453:epidemiology; D006528:Carcinoma, Hepatocellular / Q000191:economics / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control; D002648:Child; D002675:Child, Preschool; D017281:Cost of Illness; D005260:Female; D019698:Hepatitis C, Chronic / Q000150:complications / Q000188:drug therapy* / Q000191:economics* / Q000453:epidemiology; D006801:Humans; D007223:Infant; D008103:Liver Cirrhosis / Q000191:economics / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control; D008113:Liver Neoplasms / Q000191:economics / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D055815:Young Adult
chemical_list: D000998:Antiviral Agents
keywords: Australia; cirrhosis; diagnosis; directly acting antivirals; hepatitis C; hepatocellular carcinoma; treatment