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The future disease burden of hepatitis C virus infection in Sweden and the impact of different treatment strategies
Örebro University, School of Health and Medical Sciences, Örebro University, Sweden. Örebro University Hospital. Department of Infectious Diseases, , Örebro University Hospital, Örebro, Sweden.ORCID iD: 0000-0001-7248-0910
Center for Disease Analysis (CDA), Louisville CO, USA.
Department of Medicine Huddinge, Division of Infectious Diseases, Karolinska University Hospital, Karolinska Institutet, Stockholm, Sweden.
Department of Medicine Huddinge, Division of Infectious Diseases, Karolinska University Hospital, Karolinska Institutet, , Stockholm, Sweden.
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2015 (English)In: Scandinavian Journal of Gastroenterology, ISSN 0036-5521, E-ISSN 1502-7708, Vol. 50, no 2, p. 233-244Article in journal (Refereed) Published
Abstract [en]

Objective: Recently, new highly effective direct-acting antivirals (DAAs) against hepatitis C virus (HCV) were introduced. Whether these will alleviate the anticipated increase of liver disease burden in Sweden is unknown, partly because high costs may restrict the use. The objectives were to model the HCV epidemic in Sweden, the burden of disease, and the potential impact of different treatment strategies.

Material and methods: HCV disease progression was modeled to 2030. Scenarios were simulated using new DAAs with sustained annual treatment rate (n = 1130), reduced treatment rate (n = 380) to maintain budget, and increased treatment rates (n = 1430 or 2260) to reduce HCV infections.

Results: With today's triple therapies, the estimated number of serious liver complications and death are expected to peak in 2021. Using new DAAs among F0-F4 patients, an unchanged annual treatment rate can reduce the number of HCV infections by 10% by 2030; however, hepatocellular carcinoma (HCC) and mortality will remain unchanged. By reducing to 380 treatments annually and focusing on patients with advanced fibrosis (F3-F4), serious complications will remain constant but the total number of HCV infections will increase. By doubling the number of DAA treatments, HCC-incidence and liver-related deaths would decrease by 65-70% by 2030.

Conclusion: Mortality and HCC can be reduced with new DAAs and sustained treatment uptake when restricted to F2-F4 patients, or with increased uptake in F0-F4 patients. Treatment restrictions to limit cost may reduce the positive effects and increase the burden of HCV infection. These results may be important for the future strategies of HCV management.

Place, publisher, year, edition, pages
London: Informa Healthcare, 2015. Vol. 50, no 2, p. 233-244
Keywords [en]
Direct-acting antiviral agents; Epidemiology; Hepatitis C; Hepatitis C virus; Hepatocellular carcinoma; Modeling; Mortality
National Category
Gastroenterology and Hepatology
Identifiers
URN: urn:nbn:se:oru:diva-41031DOI: 10.3109/00365521.2014.990505ISI: 000347692700015PubMedID: 25515032Scopus ID: 2-s2.0-84921323762OAI: oai:DiVA.org:oru-41031DiVA, id: diva2:779399
Note

Funding Agency:

Gilead

Available from: 2015-01-12 Created: 2015-01-12 Last updated: 2018-09-14Bibliographically approved

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Duberg, Ann-Sofi

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