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“The only thing necessary for these diseases to the triumph is for good people and governments to do nothing.”

   


 
          

Hepatitis C Virus - (Virtually) All Patients Should Be Treated

Douglas R. LaBrecque, MD

Chronic Hepatitis C: Epidemiology and Economic Burden

http://www.medscape.com/viewarticle/443005_2

 

 

I 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.

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Slide 1. Worldwide Prevalence

This slide depicts a recent map of the worldwide prevalence of Hepatitis C Virus infection. 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.

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Slide 2. Estimated Hepatitis C Virus Incidence, United States, 1982-1996

This slide demonstrates that the incidence of acute Hepatitis C Virus in the United States fell between 1982 and 1996. 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 effective therapy.

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).

  


 

Healthcare costs 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).

Leigh and 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).

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Slide 3. Costs of Medical Care (year)

This cost is comparable to what we spend on asthma care in this country and of the diseases listed on this slide, Hepatitis C Virus is the only one whose morbidity and mortality are predicted to increase 2- to 3-fold over the next 20 years.