title: The disease burden of hepatitis C in Belgium: development of a realistic disease control strategy.
abstract: BACKGROUND
  Novel direct antiviral agents (DAAs) will become available soon with higher sustained viral response (SVR), fewer side-effects and higher compliance. Our aim was to evaluate different realistic strategies to control the projected increase in HCV-related disease burden in Belgium.
  
  
  METHODS
  Based on literature review, expert opinions and historical assumptions, HCV-disease progression and mortality in Belgium was modeled to 2030. Strategies exploring the impact of increased treatment, treatment delay, and treatment restrictions were developed.
  
  
  RESULTS
  Although the overall HCV prevalence is decreasing in Belgium, the burden of advanced stage HCV, including cirrhosis and hepatocellular carcinoma (HCC), is expected to increase under current treatment and cure rates. By increasing SVR to 90% from 2016 onward and the number of treated cases (from 710 to 2,050), in 2030 the cases with cirrhosis, decompensated cirrhosis and HCC would be significantly lower than in 2013. This strategy was found most efficient when applied to F2-F4 cases. To obtain comparable outcomes with F0-F4 cases, 3,490 patients should be treated. A two year delayed access to the DAAs increased HCV related morbidity and mortality by 15% relative to our strategy.
  
  
  CONCLUSIONS
  Considering the evolving burden of HCV disease and the need for efficacious usage of healthcare resources, primary application of new DAAs in Belgium should focus on patients with significant and advanced fibrosis (F2-F4), providing these new drugs without delay upon availability and increasing access to therapy.
authors.forename: P
authors.initials: P
authors.lastname: Stärkel
authors.forename: D
authors.initials: D
authors.lastname: Vandijck
authors.forename: W
authors.initials: W
authors.lastname: Laleman
authors.forename: P
authors.initials: P
authors.lastname: Van Damme
authors.forename: C
authors.initials: C
authors.lastname: Moreno
authors.forename: S
authors.initials: S
authors.lastname: Hindman
authors.forename: H
authors.initials: H
authors.lastname: Razavi
authors.forename: H
authors.initials: H
authors.lastname: Van Vlierberghe
mesh_terms: D000998:Antiviral Agents / Q000627:therapeutic use*; D001530:Belgium / Q000453:epidemiology; D006296:Health Services / Q000706:statistics & numerical data*; D019698:Hepatitis C, Chronic / Q000188:drug therapy* / Q000401:mortality*; D006801:Humans; D008103:Liver Cirrhosis / Q000188:drug therapy / Q000401:mortality; D015995:Prevalence
chemical_list: D000998:Antiviral Agents