title: Significant reduction in end-stage liver diseases burden through the national viral hepatitis therapy program in Taiwan.
abstract: A national viral hepatitis therapy program was launched in Taiwan in October 2003. This study aimed to assess the impact of the program on reduction of end-stage liver disease (ESLD) burden. Profiles of national registries of households, cancers, and death certificates were used to derive incidence and mortality of ESLDs from 2000 to 2011. Age-gender-adjusted incidence and mortality rates of hepatocellular carcinoma (HCC) and chronic liver diseases (CLDs) and cirrhosis of adults ages 30-69 years were compared before and after launching the program using Poisson's regression models. A total of 157,570 and 61,823 patients (15%-25% of those eligible for reimbursed treatment) received therapy for chronic hepatitis B and C, respectively, by 2011. There were 42,526 CLDs and cirrhosis deaths, 47,392 HCC deaths, and 74,832 incident HCC cases occurred in 140,814,448 person-years from 2000 to 2011. Male gender and elder age were associated with a significantly increased risk of CLDs and cirrhosis and HCC. Mortality and incidence rates of ESLDs decreased continuously from 2000 to 2003 (before therapy program) through 2004-2007 to 2008-2011 in all age and gender groups. The age-gender-adjusted rate ratio (95% confidence interval; P value) in 2008-2011 was 0.78 (0.76-0.80; P < 0.001) for CLDs and cirrhosis mortality, 0.76 (0.75-0.78; P < 0.005) for HCC mortality, and 0.86 (0.85-0.88; P < 0.005) for HCC incidence using 2000-2003 as the reference period (rate ratio = 1.0).
  
  
  CONCLUSIONS
  The national viral hepatitis therapy program has significantly reduced the mortality of CLDs and cirrhosis and incidence and mortality of HCC.
authors.affiliation: Graduate Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan; Taiwan Cancer Registry, Taipei, Taiwan.
authors.forename: Chun-Ju
authors.initials: CJ
authors.lastname: Chiang
authors.forename: Ya-Wen
authors.initials: YW
authors.lastname: Yang
authors.forename: Jin-De
authors.initials: JD
authors.lastname: Chen
authors.forename: San-Lin
authors.initials: SL
authors.lastname: You
authors.forename: Hwai-I
authors.initials: HI
authors.lastname: Yang
authors.forename: Mei-Hsuan
authors.initials: MH
authors.lastname: Lee
authors.forename: Mei-Shu
authors.initials: MS
authors.lastname: Lai
authors.forename: Chien-Jen
authors.initials: CJ
authors.lastname: Chen
mesh_terms: D000328:Adult; D000368:Aged; D006528:Carcinoma, Hepatocellular / Q000150:complications / Q000453:epidemiology / Q000517:prevention & control*; D017281:Cost of Illness; D058625:End Stage Liver Disease / Q000150:complications / Q000453:epidemiology / Q000517:prevention & control*; D006525:Hepatitis, Viral, Human / Q000150:complications / Q000188:drug therapy*; D006801:Humans; D015994:Incidence; D008103:Liver Cirrhosis / Q000150:complications / Q000453:epidemiology / Q000517:prevention & control*; D008113:Liver Neoplasms / Q000150:complications / Q000453:epidemiology / Q000517:prevention & control*; D008875:Middle Aged; D009313:National Health Programs; D013624:Taiwan