title: Modeling the Health and Economic Burden of Hepatitis C Virus in Switzerland.
abstract: BACKGROUND
  Chronic hepatitis C virus infection is a major cause of liver disease in Switzerland and carries a significant cost burden. Currently, only conservative strategies are in place to mitigate the burden of hepatitis C in Switzerland. This study expands on previously described modeling efforts to explore the impact of: no treatment, and treatment to reduce HCC and mortality. Furthermore, the costs associated with untreated HCV were modeled.
  
  
  METHODS
  Hepatitis C disease progression and mortality were modeled. Baseline historical assumptions were collected from the literature and expert interviews and strategies were developed to show the impact of different levels of intervention (improved drug cure rates, treatment and diagnosis) until 2030.
  
  
  RESULTS
  Under the historical standard of care, the number of advanced stage cases was projected to increase until 2030, at which point the annual economic burden of untreated viremic infections was projected to reach €96.8 (95% Uncertainty Interval: €36 - €232) million. Scenarios to reduce HCV liver-related mortality by 90% by 2030 required treatment of 4,190 ≥F2 or 3,200 ≥F3 patients annually by 2018 using antivirals with a 95% efficacy rate. Delaying the implementation of these scenarios by 2 or 5 years reduced the impact on mortality to 75% and 57%, respectively.
  
  
  CONCLUSIONS
  With today's treatment efficacy and uptake rates, hepatitis C disease burden is expected to increase through 2030. A substantial reduction in disease burden can be achieved by means of both higher efficacy drugs and increased treatment uptake. However, these efforts cannot be undertaken without a simultaneous effort to diagnose more infections.
authors.affiliation: Swiss HPB (Hepato-Pancreato-Biliary) Center and Department of Gastroenterology and Hepatology, University Hospital Zürich, Zürich, Switzerland.
authors.forename: Beat
authors.initials: B
authors.lastname: Müllhaupt
authors.affiliation: Arud Centres for Addiction Medicine, Zürich, Switzerland.
authors.forename: Philip
authors.initials: P
authors.lastname: Bruggmann
authors.affiliation: Gastroenterology Department, Ospedale Cantonale, Bellinzona, Switzerland.
authors.forename: Florian
authors.initials: F
authors.lastname: Bihl
authors.affiliation: Center for Disease Analysis (CDA), Louisville, Colorado, United States of America.
authors.forename: Sarah
authors.initials: S
authors.lastname: Blach
authors.affiliation: Consultant, Ruelle des Chataigniers 1, CH-1026 Denges VD, Switzerland.
authors.forename: Daniel
authors.initials: D
authors.lastname: Lavanchy
authors.affiliation: Center for Disease Analysis (CDA), Louisville, Colorado, United States of America.
authors.forename: Homie
authors.initials: H
authors.lastname: Razavi
authors.affiliation: Division of Gastroenterology & Hepatology, Cantonal Hospital St. Gallen, St. Gallen, Switzerland.
authors.forename: David
authors.initials: D
authors.lastname: Semela
authors.affiliation: Divisions of Gastroenterology and Hepatology and of Clinical Pathology, University Hospital, Genève, Switzerland.
authors.forename: Francesco
authors.initials: F
authors.lastname: Negro
mesh_terms: D000293:Adolescent; D000328:Adult; D000998:Antiviral Agents / Q000627:therapeutic use*; D005260:Female; D016174:Hepacivirus / Q000472:pathogenicity; D019698:Hepatitis C, Chronic / Q000191:economics / Q000453:epidemiology* / Q000628:therapy; D006801:Humans; D008103:Liver Cirrhosis / Q000191:economics / Q000453:epidemiology* / Q000628:therapy; D016031:Liver Transplantation; D008297:Male; D008875:Middle Aged; D013557:Switzerland
chemical_list: D000998:Antiviral Agents