Estimating future hepatitis C morbidity, mortality, and costs in the United States (original) (raw)

Abstract

OBJECTIVES: This study estimated future morbidity, mortality, and costs resulting from hepatitis C virus (HCV). METHODS: We used a computer cohort simulation of the natural history of HCV in the US population. RESULTS: From the year 2010 through 2019, our model projected 165,900 deaths from chronic liver disease, 27,200 deaths from hepatocellular carcinoma, and 10.7billionindirectmedicalexpendituresforHCV.Duringthisperiod,HCVmayleadto720,700yearsofdecompensatedcirrhosisandhepatocellularcarcinomaandtothelossof1.83millionyearsoflifeinthoseyoungerthan65atasocietalcostof10.7 billion in direct medical expenditures for HCV. During this period, HCV may lead to 720,700 years of decompensated cirrhosis and hepatocellular carcinoma and to the loss of 1.83 million years of life in those younger than 65 at a societal cost of 10.7billionindirectmedicalexpendituresforHCV.Duringthisperiod,HCVmayleadto720,700yearsofdecompensatedcirrhosisandhepatocellularcarcinomaandtothelossof1.83millionyearsoflifeinthoseyoungerthan65atasocietalcostof21.3 and $54.2 billion, respectively. In sensitivity analysis, these estimates depended on (1) whether patients with HCV and normal transaminase levels develop progressive liver disease, (2) the extent of alcohol ingestion, and (3) the likelihood of dying from other causes related to the route of HCV acquisition. CONCLUSIONS: Our results confirm prior Centers for Disease Control and Prevention projections and suggest that HCV may lead to a substantial health and economic burden over the next 10 to 20 years.

Full Text

The Full Text of this article is available as a PDF (132.1 KB).

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Alter M. J. Hepatitis C: a sleeping giant? Am J Med. 1991 Sep 16;91(3B):112S–115S. doi: 10.1016/0002-9343(91)90354-z. [DOI] [PubMed] [Google Scholar]
  2. Alter M. J., Kruszon-Moran D., Nainan O. V., McQuillan G. M., Gao F., Moyer L. A., Kaslow R. A., Margolis H. S. The prevalence of hepatitis C virus infection in the United States, 1988 through 1994. N Engl J Med. 1999 Aug 19;341(8):556–562. doi: 10.1056/NEJM199908193410802. [DOI] [PubMed] [Google Scholar]
  3. Alter M. J., Mast E. E. The epidemiology of viral hepatitis in the United States. Gastroenterol Clin North Am. 1994 Sep;23(3):437–455. [PubMed] [Google Scholar]
  4. Alter M. J. Occupational exposure to hepatitis C virus: a dilemma. Infect Control Hosp Epidemiol. 1994 Dec;15(12):742–744. doi: 10.1086/646850. [DOI] [PubMed] [Google Scholar]
  5. Ascher N. L., Lake J. R., Emond J., Roberts J. Liver transplantation for hepatitis C virus-related cirrhosis. Hepatology. 1994 Jul;20(1 Pt 2):24S–27S. doi: 10.1016/0270-9139(94)90269-0. [DOI] [PubMed] [Google Scholar]
  6. Beck J. R., Pauker S. G. The Markov process in medical prognosis. Med Decis Making. 1983;3(4):419–458. doi: 10.1177/0272989X8300300403. [DOI] [PubMed] [Google Scholar]
  7. Bennett W. G., Inoue Y., Beck J. R., Wong J. B., Pauker S. G., Davis G. L. Estimates of the cost-effectiveness of a single course of interferon-alpha 2b in patients with histologically mild chronic hepatitis C. Ann Intern Med. 1997 Nov 15;127(10):855–865. doi: 10.7326/0003-4819-127-10-199711150-00001. [DOI] [PubMed] [Google Scholar]
  8. Benvegnù L., Fattovich G., Noventa F., Tremolada F., Chemello L., Cecchetto A., Alberti A. Concurrent hepatitis B and C virus infection and risk of hepatocellular carcinoma in cirrhosis. A prospective study. Cancer. 1994 Nov 1;74(9):2442–2448. doi: 10.1002/1097-0142(19941101)74:9<2442::aid-cncr2820740909>3.0.co;2-#. [DOI] [PubMed] [Google Scholar]
  9. Boring C. C., Squires T. S., Tong T. Cancer statistics, 1991. CA Cancer J Clin. 1991 Jan-Feb;41(1):19–36. doi: 10.3322/canjclin.41.1.19. [DOI] [PubMed] [Google Scholar]
  10. Christensen E., Krintel J. J., Hansen S. M., Johansen J. K., Juhl E. Prognosis after the first episode of gastrointestinal bleeding or coma in cirrhosis. Survival and prognostic factors. Scand J Gastroenterol. 1989 Oct;24(8):999–1006. doi: 10.3109/00365528909089247. [DOI] [PubMed] [Google Scholar]
  11. Desmet V. J., Gerber M., Hoofnagle J. H., Manns M., Scheuer P. J. Classification of chronic hepatitis: diagnosis, grading and staging. Hepatology. 1994 Jun;19(6):1513–1520. [PubMed] [Google Scholar]
  12. Deuffic S., Buffat L., Poynard T., Valleron A. J. Modeling the hepatitis C virus epidemic in France. Hepatology. 1999 May;29(5):1596–1601. doi: 10.1002/hep.510290528. [DOI] [PubMed] [Google Scholar]
  13. Di Bisceglie A. M. Hepatitis C and hepatocellular carcinoma. Hepatology. 1997 Sep;26(3 Suppl 1):34S–38S. doi: 10.1002/hep.510260706. [DOI] [PubMed] [Google Scholar]
  14. El-Serag H. B., Mason A. C. Rising incidence of hepatocellular carcinoma in the United States. N Engl J Med. 1999 Mar 11;340(10):745–750. doi: 10.1056/NEJM199903113401001. [DOI] [PubMed] [Google Scholar]
  15. Fattovich G., Giustina G., Degos F., Tremolada F., Diodati G., Almasio P., Nevens F., Solinas A., Mura D., Brouwer J. T. Morbidity and mortality in compensated cirrhosis type C: a retrospective follow-up study of 384 patients. Gastroenterology. 1997 Feb;112(2):463–472. doi: 10.1053/gast.1997.v112.pm9024300. [DOI] [PubMed] [Google Scholar]
  16. Finkler S. A. The distinction between cost and charges. Ann Intern Med. 1982 Jan;96(1):102–109. doi: 10.7326/0003-4819-96-1-102. [DOI] [PubMed] [Google Scholar]
  17. Hoofnagle J. H. Hepatitis C: the clinical spectrum of disease. Hepatology. 1997 Sep;26(3 Suppl 1):15S–20S. doi: 10.1002/hep.510260703. [DOI] [PubMed] [Google Scholar]
  18. Hurwitz E. S., Holman R. C., Strine T. W., Chorba T. L. Chronic liver disease mortality in the United States, 1979 through 1989. Am J Public Health. 1995 Sep;85(9):1256–1260. doi: 10.2105/ajph.85.9.1256. [DOI] [PMC free article] [PubMed] [Google Scholar]
  19. Joe G. W., Lehman W., Simpson D. D. Addict death rates during a four-year posttreatment follow-up. Am J Public Health. 1982 Jul;72(7):703–709. doi: 10.2105/ajph.72.7.703. [DOI] [PMC free article] [PubMed] [Google Scholar]
  20. Kilpe V. E., Krakauer H., Wren R. E. An analysis of liver transplant experience from 37 transplant centers as reported to Medicare. Transplantation. 1993 Sep;56(3):554–561. doi: 10.1097/00007890-199309000-00012. [DOI] [PubMed] [Google Scholar]
  21. Koretz R. L., Abbey H., Coleman E., Gitnick G. Non-A, non-B post-transfusion hepatitis. Looking back in the second decade. Ann Intern Med. 1993 Jul 15;119(2):110–115. doi: 10.7326/0003-4819-119-2-199307150-00003. [DOI] [PubMed] [Google Scholar]
  22. Kuntz K. M., Weinstein M. C. Life expectancy biases in clinical decision modeling. Med Decis Making. 1995 Apr-Jun;15(2):158–169. doi: 10.1177/0272989X9501500209. [DOI] [PubMed] [Google Scholar]
  23. Mathurin P., Moussalli J., Cadranel J. F., Thibault V., Charlotte F., Dumouchel P., Cazier A., Huraux J. M., Devergie B., Vidaud M. Slow progression rate of fibrosis in hepatitis C virus patients with persistently normal alanine transaminase activity. Hepatology. 1998 Mar;27(3):868–872. doi: 10.1002/hep.510270333. [DOI] [PubMed] [Google Scholar]
  24. Okuda K., Ohtsuki T., Obata H., Tomimatsu M., Okazaki N., Hasegawa H., Nakajima Y., Ohnishi K. Natural history of hepatocellular carcinoma and prognosis in relation to treatment. Study of 850 patients. Cancer. 1985 Aug 15;56(4):918–928. doi: 10.1002/1097-0142(19850815)56:4<918::aid-cncr2820560437>3.0.co;2-e. [DOI] [PubMed] [Google Scholar]
  25. Poynard T., Bedossa P., Opolon P. Natural history of liver fibrosis progression in patients with chronic hepatitis C. The OBSVIRC, METAVIR, CLINIVIR, and DOSVIRC groups. Lancet. 1997 Mar 22;349(9055):825–832. doi: 10.1016/s0140-6736(96)07642-8. [DOI] [PubMed] [Google Scholar]
  26. Reindollar R. W. Hepatitis C and the correctional population. Am J Med. 1999 Dec 27;107(6B):100S–103S. doi: 10.1016/s0002-9343(99)00394-0. [DOI] [PubMed] [Google Scholar]
  27. Salerno F., Borroni G., Moser P., Badalamenti S., Cassarà L., Maggi A., Fusini M., Cesana B. Survival and prognostic factors of cirrhotic patients with ascites: a study of 134 outpatients. Am J Gastroenterol. 1993 Apr;88(4):514–519. [PubMed] [Google Scholar]
  28. Seeff L. B., Buskell-Bales Z., Wright E. C., Durako S. J., Alter H. J., Iber F. L., Hollinger F. B., Gitnick G., Knodell R. G., Perrillo R. P. Long-term mortality after transfusion-associated non-A, non-B hepatitis. The National Heart, Lung, and Blood Institute Study Group. N Engl J Med. 1992 Dec 31;327(27):1906–1911. doi: 10.1056/NEJM199212313272703. [DOI] [PubMed] [Google Scholar]
  29. Sonnenberg F. A., Beck J. R. Markov models in medical decision making: a practical guide. Med Decis Making. 1993 Oct-Dec;13(4):322–338. doi: 10.1177/0272989X9301300409. [DOI] [PubMed] [Google Scholar]
  30. Soto B., Sánchez-Quijano A., Rodrigo L., del Olmo J. A., García-Bengoechea M., Hernández-Quero J., Rey C., Abad M. A., Rodríguez M., Sales Gilabert M. Human immunodeficiency virus infection modifies the natural history of chronic parenterally-acquired hepatitis C with an unusually rapid progression to cirrhosis. J Hepatol. 1997 Jan;26(1):1–5. doi: 10.1016/s0168-8278(97)80001-3. [DOI] [PubMed] [Google Scholar]
  31. Takahashi M., Yamada G., Miyamoto R., Doi T., Endo H., Tsuji T. Natural course of chronic hepatitis C. Am J Gastroenterol. 1993 Feb;88(2):240–243. [PubMed] [Google Scholar]
  32. Tremolada F., Casarin C., Alberti A., Drago C., Tagger A., Ribero M. L., Realdi G. Long-term follow-up of non-A, non-B (type C) post-transfusion hepatitis. J Hepatol. 1992 Nov;16(3):273–281. doi: 10.1016/s0168-8278(05)80657-9. [DOI] [PubMed] [Google Scholar]
  33. Ventura S. J., Anderson R. N., Martin J. A., Smith B. L. Births and deaths: preliminary data for 1997. Natl Vital Stat Rep. 1998 Oct 7;47(4):1–41. [PubMed] [Google Scholar]
  34. Wiley T. E., McCarthy M., Breidi L., McCarthy M., Layden T. J. Impact of alcohol on the histological and clinical progression of hepatitis C infection. Hepatology. 1998 Sep;28(3):805–809. doi: 10.1002/hep.510280330. [DOI] [PubMed] [Google Scholar]
  35. Wong J. B., Bennett W. G., Koff R. S., Pauker S. G. Pretreatment evaluation of chronic hepatitis C: risks, benefits, and costs. JAMA. 1998 Dec 23;280(24):2088–2093. doi: 10.1001/jama.280.24.2088. [DOI] [PubMed] [Google Scholar]
  36. Wong J. B. Interferon treatment for chronic hepatitis B or C infection: costs and effectiveness. Acta Gastroenterol Belg. 1998 Apr-Jun;61(2):238–242. [PubMed] [Google Scholar]
  37. Wong L. L., McFall P., Wong L. M. The cost of dying of end-stage liver disease. Arch Intern Med. 1997 Jul 14;157(13):1429–1432. [PubMed] [Google Scholar]
  38. Yousuf M., Nakano Y., Tanaka E., Sodeyama T., Kiyosawa K. Persistence of viremia in patients with type-C chronic hepatitis during long-term follow-up. Scand J Gastroenterol. 1992 Sep;27(9):812–816. doi: 10.3109/00365529209011189. [DOI] [PubMed] [Google Scholar]
  39. Yu M. C., Yuan J. M., Ross R. K., Govindarajan S. Presence of antibodies to the hepatitis B surface antigen is associated with an excess risk for hepatocellular carcinoma among non-Asians in Los Angeles County, California. Hepatology. 1997 Jan;25(1):226–228. doi: 10.1002/hep.510250141. [DOI] [PubMed] [Google Scholar]
  40. Zarski J. P., Bohn B., Bastie A., Pawlotsky J. M., Baud M., Bost-Bezeaux F., Tran van Nhieu J., Seigneurin J. M., Buffet C., Dhumeaux D. Characteristics of patients with dual infection by hepatitis B and C viruses. J Hepatol. 1998 Jan;28(1):27–33. doi: 10.1016/s0168-8278(98)80198-0. [DOI] [PubMed] [Google Scholar]