Simulation of hepatitis C based on a mandatory reporting system

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Objective Hepatitis C is a major cause of liver disease in European countries. We aimed to assess the current and future disease burden of hepatitis C.Setting A representative data set of hepatitis C was applied to a validated computer model.Methods The mandatory reporting of positive hepatitis C virus (HCV) test results by all medical laboratories in Switzerland and the clinical data obtained by questionnaire for each positive test from the treating physicians created a unique, representative epidemiological database allowing the determination of the age distribution of acute (i.e. newly acquired) and chronic HCV infections. Based on these data and a simulation model of the natural history of hepatitis C, we estimated the prevalence of HCV infection, future morbidity/mortality from cirrhosis/hepatocellular carcinoma and costs.Results Our analysis estimates a prevalence of anti-HCV in Switzerland of 1.25–1.75%, which is slightly higher than prior reports (0.5–1%) derived by extrapolation from selected populations. Although new HCV infections decreased after 1990, our analysis predicts that HCV-related morbidity and mortality will increase by 70–90%, reaching a maximum in 2015–2020, largely from complications in cases already prevalent in 1998. The model predicts that the incidence of cirrhosis will begin to decrease after 2005–2010. Antiviral treatment reduces disease burden by approximately 5%. Undiscounted HCV-related annual direct costs will more than double and reach a maximum of almost US$33 million in 2020.Conclusions The incidence of HCV-related cirrhosis is predicted to decrease after 2005–2010, while disease burden and costs due to complications are estimated to continue to increase until 2015–2020.

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