title: Projections of the current and future disease burden of hepatitis C virus infection in Malaysia.
abstract: BACKGROUND
  The prevalence of hepatitis C virus (HCV) infection in Malaysia has been estimated at 2.5% of the adult population. Our objective, satisfying one of the directives of the WHO Framework for Global Action on Viral Hepatitis, was to forecast the HCV disease burden in Malaysia using modelling methods.
  
  
  METHODS
  An age-structured multi-state Markov model was developed to simulate the natural history of HCV infection. We tested three historical incidence scenarios that would give rise to the estimated prevalence in 2009, and calculated the incidence of cirrhosis, end-stage liver disease, and death, and disability-adjusted life-years (DALYs) under each scenario, to the year 2039. In the baseline scenario, current antiviral treatment levels were extended from 2014 to the end of the simulation period. To estimate the disease burden averted under current sustained virological response rates and treatment levels, the baseline scenario was compared to a counterfactual scenario in which no past or future treatment is assumed.
  
  
  RESULTS
  In the baseline scenario, the projected disease burden for the year 2039 is 94,900 DALYs/year (95% credible interval (CrI): 77,100 to 124,500), with 2,002 (95% CrI: 1340 to 3040) and 540 (95% CrI: 251 to 1,030) individuals predicted to develop decompensated cirrhosis and hepatocellular carcinoma, respectively, in that year. Although current treatment practice is estimated to avert a cumulative total of 2,200 deaths from DC or HCC, a cumulative total of 63,900 HCV-related deaths is projected by 2039.
  
  
  CONCLUSIONS
  The HCV-related disease burden is already high and is forecast to rise steeply over the coming decades under current levels of antiviral treatment. Increased governmental resources to improve HCV screening and treatment rates and to reduce transmission are essential to address the high projected HCV disease burden in Malaysia.
authors.affiliation: Centre of Excellence for Research in AIDS (CERiA), University of Malaya, Kuala Lumpur, Malaysia; Centre for Infectious Disease Control, National Institute for Public Health and the Environment, Bilthoven, The Netherlands; School of Health & Life Sciences, Glasgow Caledonian University, Glasgow, Scotland.
authors.forename: Scott A
authors.initials: SA
authors.lastname: McDonald
authors.affiliation: Julius Centre, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia.
authors.forename: Maznah
authors.initials: M
authors.lastname: Dahlui
authors.affiliation: Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia.
authors.forename: Rosmawati
authors.initials: R
authors.lastname: Mohamed
authors.affiliation: Centre of Excellence for Research in AIDS (CERiA), University of Malaya, Kuala Lumpur, Malaysia.
authors.forename: Herlianna
authors.initials: H
authors.lastname: Naning
authors.affiliation: Julius Centre, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia.
authors.forename: Fatiha Hana
authors.initials: FH
authors.lastname: Shabaruddin
authors.affiliation: Centre of Excellence for Research in AIDS (CERiA), University of Malaya, Kuala Lumpur, Malaysia; Julius Centre, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia.
authors.forename: Adeeba
authors.initials: A
authors.lastname: Kamarulzaman
mesh_terms: D000208:Acute Disease; D002138:Calibration; D006528:Carcinoma, Hepatocellular / Q000821:virology; D017281:Cost of Illness; D018450:Disease Progression; D016174:Hepacivirus / Q000502:physiology*; D006526:Hepatitis C / Q000453:epidemiology* / Q000821:virology; D006801:Humans; D015994:Incidence; D008296:Malaysia / Q000453:epidemiology; D008954:Models, Biological; D011336:Probability; D015819:Substance Abuse, Intravenous / Q000453:epidemiology