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Chronic Hepatitis C:
Epidemiology and Economic Burden
will be discussing the data which I believe indicate that virtually all
hepatitis C (Hepatitis C Virus) patients should be treated. Before discussing the
controversial aspects of this topic, however, I will discuss the facts,
just the facts, about which there is little disagreement.
The prevalence of
infection is greater than 10% in those areas shown in red, which include
areas of Asia, South America, and Africa. Much of the map indicates that
between 2.5% and 10% of the population are chronically infected. The
Centers for Disease Control (CDC) estimates that 1.8% of the US
population is currently infected.
One point eight
percent of the US population equates to approximately 4 million US
citizens and there are 170 million individuals infected worldwide.
Approximately 30,000 new infections occur each year in the United
States. Approximately 20% of these individuals will progress to develop
cirrhosis over the following 20 years. Eight to 10,000 individuals die
each year in the United States from Hepatitis C Virus complications. This occurs at a
rate of 2% to 5% per year once the patient develops cirrhosis and the
risk of developing hepatocellular carcinoma (HCC) is 3% to 7% per year
after the development of cirrhosis. Overall, 35% to 40% of all liver
transplants performed in the US and Europe are performed for Hepatitis C Virus.
During that time
there were improved diagnostic tests for Hepatitis C Virus and yet the incident rate
fell despite our improved ability to diagnose the disease. This was due
to a decline in the disease among transfusion recipients and a decline
among injection drug users. Because of this there is great hope that
there will eventually be a corresponding fall in liver disease related
deaths due to this decreased infection rate as well as the development
of improved selective treatments.
However, when I
add the prevalence of Hepatitis C Virus to this graph, you will note that the
prevalence has continued to increase despite the decreased infection
rate due to the chronic nature of Hepatitis C Virus infection and the body's inability
to rid itself of the virus on its own. This emphasizes the need for an
Death rates due
to Hepatitis C Virus are expected to increase over the next 20 years. Estimates of
death rates may underestimate the actual death rate because of
underreporting of liver disease and underreporting of deaths due to
liver disease on death certificates and in other databases(Wong et al.
Am J Public Health. 2000;1990:1562).
for Hepatitis C Virus include managing patients' symptoms, managing other organ
involvement, treating Hepatitis C Virus with antiviral agents, and managing end-stage
liver disease as well as the cost of liver transplantation. Wong and
coworkers estimated that the annual US healthcare cost for Hepatitis C Virus will
exceed $1 billion by the year 2008 and continue to increase up to at
least the year 2015 (Wong et al. Am J Public Health. 2000;1990:1562).
colleagues, using a more inclusive method of estimating costs, arrived
at a dramatically higher figure and estimated the yearly cost of Hepatitis C Virus in
the United States had already exceeded $5 billion in 1997 (Leigh et al.
Arch Int Med. 2001;161:2231).