title: Tackling the burden of the hepatitis C virus in the UK: characterizing and assessing the clinical and economic consequences.
abstract: OBJECTIVE
  The hepatitis C virus (HCV) remains a significant public health issue. This study aimed to quantify the clinical and economic burden of chronic hepatitis C in the UK, stratified by disease severity, age and awareness of infection, with concurrent assessment of the impact of implementing a treatment prioritization approach.
  
  
  METHODS
  A previously published back projection, natural history and cost-effectiveness HCV model was adapted to a UK setting to estimate the disease burden of chronic hepatitis C and end-stage liver disease (ESLD) between 1980 and 2035. A published meta-regression analysis informed disease progression, and UK-specific data informed other model inputs.
  
  
  RESULTS
  At 2015, prevalence of chronic hepatitis C is estimated to be 241,487 with 22.20%, 33.72%, 17.22%, 16.67% and 10.19% of patients in METAVIR stages F0, F1, F2, F3 and F4, respectively, but is estimated to fall to 193,999 by 2035. ESLD incidence is predicted to peak in 2031. Assuming all patients are diagnosed and treatment is prioritized in F3 and F4 using highly efficacious direct-acting antiviral (DAA) regimens, a 69.85% reduction in ESLD incidence is predicted between 2015 and 2035, and the cumulative discounted medical expenditure associated with the lifetime management of incident ESLD events is estimated to be £1,202,827,444.
  
  
  CONCLUSIONS
  The prevalence of chronic hepatitis C is expected to fall in coming decades; however, the ongoing financial burden is expected to be high due to an increase in ESLD incidence. This study highlights the significant costs of managing ESLD that are likely to be incurred without the employment of effective treatment approaches.
authors.affiliation: Health Economics and Outcomes Research Ltd, Cardiff, UK. Electronic address: tom.ward@heor.co.uk.
authors.forename: T
authors.initials: T
authors.lastname: Ward
authors.affiliation: Health Economics and Outcomes Research Ltd, Cardiff, UK; Department of Public Health, University of Adelaide, Australia; School of Medicine, University of Nottingham, UK.
authors.forename: J
authors.initials: J
authors.lastname: Gordon
authors.affiliation: Health Economics and Outcomes Research Ltd, Cardiff, UK.
authors.forename: H
authors.initials: H
authors.lastname: Bennett
authors.affiliation: Health Economics and Outcomes Research Ltd, Cardiff, UK.
authors.forename: S
authors.initials: S
authors.lastname: Webster
authors.affiliation: Health Economics and Outcomes Research Ltd, Cardiff, UK.
authors.forename: D
authors.initials: D
authors.lastname: Sugrue
authors.affiliation: Health Economics and Outcomes Research Ltd, Cardiff, UK.
authors.forename: B
authors.initials: B
authors.lastname: Jones
authors.affiliation: UK HEOR, Bristol-Myers Squibb Pharmaceuticals Ltd, Uxbridge, UK.
authors.forename: M
authors.initials: M
authors.lastname: Brenner
authors.affiliation: Health Economics and Outcomes Research Ltd, Cardiff, UK; School of Human & Health Sciences, Swansea University, Swansea, UK.
authors.forename: P
authors.initials: P
authors.lastname: McEwan
mesh_terms: D000998:Antiviral Agents / Q000191:economics / Q000627:therapeutic use; D017281:Cost of Illness; D058625:End Stage Liver Disease / Q000191:economics / Q000453:epidemiology; D019698:Hepatitis C, Chronic / Q000191:economics* / Q000453:epidemiology* / Q000628:therapy; D006801:Humans; D015995:Prevalence; D006113:United Kingdom / Q000453:epidemiology
chemical_list: D000998:Antiviral Agents
keywords: Back projection; Chronic hepatitis C; Fibrosis; HCV; Public health