The end of hepatitis C?

A new report published in the Journal of Viral Hepatitis has shown for the first time that the elimination of hepatitis C could now be possible, if testing and treatment rates are increased.¹ This report coincides with the start of the scientific conference, the International Liver Meeting, in London, 9 – 13 April 2014.

Using new modelling techniques, clinicians responsible for the treatment of hepatitis C, statisticians and epidemiologists across 15 countries investigated how increasing treatment success and the number of patients treated per year could lead to a 90% reduction in the total infected population by 2030 – the clinical definition of disease elimination.¹ The research was supported by an educational grant from Gilead Sciences.

“This is the first analysis of its kind to establish how country health services and governments can work to eliminate a disease, within a predictable timeframe”, commented Professor Graham Foster, Editor-in-Chief, Journal of Viral Hepatitis. “Hepatitis C is a curable disease, but today, only 3% of people infected with the virus currently achieve cure. The research shows that treating only 10% of the diagnosed population per year, would ultimately lead to disease elimination by 2030. At lower rates, new infections would keep prevalence higher.¹”

Each contributing country has determined their own local strategy to achieve the elimination of hepatitis C. Across the 15 countries, research concluded that if newer, more effective medicines are implemented but today’s treatment rates remain the same, only moderate decreases in hepatitis C-related illness and death would be seen.¹ However, by taking a two pronged approach of improving treatment efficacy and increasing annual treatment rates from the current average of 2.2% to 10%, elimination of hepatitis C is achievable.¹

Hepatitis C is a global public health issue and is estimated to affect around nine million people across Europe.² People infected with hepatitis C may not experience any symptoms for 20-30 years but by the time patients are symptomatic, the virus may have led to the development of severe complications including cirrhosis and liver failure.³

Hepatitis C is the leading cause of liver transplantation in the EU, with 62% of all end stage liver disease costs associated with transplants.⁴ In Europe the total medical cost to treat the complications of hepatitis C (hepatocellular carcinoma, liver transplant and cirrhosis) per person per year is €13,690, €118,162 and €12,196 respectively.⁵

“Hepatitis C prevalence in the majority of European countries has now peaked. The number of new infections remains stable due to the success of some initiatives to reduce the risk of transmission (e.g. blood screening and needle exchange programmes). However, the ticking time bomb for governments and health systems is that the observed complications from hepatitis C infection are increasing as the population ages. These complications are what will have the greatest cost impact and so timely identification and treatment of hepatitis C is paramount in order to reduce the future costs to the health system and burden on the patient,” said Professor Graham Foster.

Five individual country research findings will be presented at the International Liver Meeting. Each of the 15 contributing country’s findings will be important to inform the development of effective hepatitis C management strategies to be implemented by governments in order to eliminate hepatitis C.

References

1. Wedemeyer H, et al. Strategies to manage hepatitis C virus disease burden. Journal of Viral Hepatitis, published online 9^th April 2014. http://onlinelibrary.wiley.com/doi/10.1111/jvh.2014.21.issue-s1/issuetoc [Accessed April 2014]
2. Hatzakis A et al.. J Virol Hepat 2011; 18 (s1):1–16
3. Toulouse, B. Hepatitis C Fact Sheet. HCV Advocacy – NATAP. Available from http://www.hepcadvocacy.org/factsheets/HepatitisC.pdf [Accessed April 2014]
4. Blachier M et al. on behalf of the European Association for the Study of the Liver (EASL)The Burden of Liver Disease in Europe: A review of available epidemiological data Available at: http://hepctrust-archive.nam.org.uk/Resources/HepC%20New/Documents/The%20burden%20of%20liver%20disease%20in%20Europe%20-%20EASL%20report%20Feb%202013.pdf [Accessed April 2014]
5. El Khoury A et al.  J Med Econ 2012; 15(5):887-96