title: Disease burden of chronic hepatitis C among immigrants in Canada.
abstract: Immigrants with chronic hepatitis C (CHC) in Canada have doubled risk of hepatocellular carcinoma. To measure the burden of CHC among immigrants in Canada. A decision analytic model was developed to compare immigrants with CHC and age-matched immigrants without CHC for survival years, quality-adjusted life-years (QALYs) and medical costs per life year. Hepatitis C epidemiology among immigrants was based on hepatitis C prevalence in their home countries. A cohort of immigrant patients was retrospectively followed up to estimate fibrosis stage distribution, treatment patterns and prognosis of compensated cirrhosis. Other model variables were based on published sources. Base case analysis, one-way sensitivity analysis and probabilistic sensitivity analysis were performed to measure the burden of CHC and assess the impact of uncertainty associated with model variables on the burden of CHC. CHC could reduce survival by 9.6 years [95% credible interval (CI): 8.0-10.9 years], reduce QALYs by 9.5 years (95% CI: 6.0-13.8 years) and increase medical costs per life year by $1950 (95% CI: $1518 to $2486, 2006 Canadian dollars). Because nearly half of immigrants with CHC were not diagnosed until the development of cirrhosis, the burden of CHC was highly sensitive to the risks of liver-related complications and mortality but insensitive to pegylated interferon plus ribavirin. The burden of CHC among immigrants in Canada is substantial mainly due to liver-related complications and mortality. The delay in diagnosis was another important contributor to the burden of CHC among immigrants.
authors.affiliation: Toronto Health Economics and Technology Assessment Collaborative, University of Toronto, Toronto, ON, Canada.|Division of Social and Administrative Pharmacy, Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, ON, Canada.
authors.forename: W
authors.initials: W
authors.lastname: Chen
authors.affiliation: Toronto Health Economics and Technology Assessment Collaborative, University of Toronto, Toronto, ON, Canada.|Division of Social and Administrative Pharmacy, Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, ON, Canada.|Department of Medicine, University Health Network, University of Toronto, Toronto, ON, Canada.
authors.forename: M
authors.initials: M
authors.lastname: Krahn
mesh_terms: D000998:Antiviral Agents / Q000627:therapeutic use; D002170:Canada / Q000453:epidemiology; D006528:Carcinoma, Hepatocellular / Q000453:epidemiology* / Q000401:mortality / Q000821:virology; D003362:Cost-Benefit Analysis; D004359:Drug Therapy, Combination; D054242:Emigrants and Immigrants; D017048:Health Care Costs; D016174:Hepacivirus; D019698:Hepatitis C, Chronic / Q000188:drug therapy / Q000191:economics / Q000453:epidemiology* / Q000821:virology; D006801:Humans; D016898:Interferon-alpha / Q000627:therapeutic use; D008113:Liver Neoplasms / Q000453:epidemiology* / Q000401:mortality / Q000821:virology; D008390:Markov Chains; D008962:Models, Theoretical; D011092:Polyethylene Glycols / Q000627:therapeutic use; D019057:Quality-Adjusted Life Years; D012189:Retrospective Studies; D012254:Ribavirin / Q000627:therapeutic use
chemical_list: D000998:Antiviral Agents; D016898:Interferon-alpha; D011092:Polyethylene Glycols; D012254:Ribavirin
keywords: Canada; Markov model; chronic hepatitis C; disease burden; immigrant