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Effective new drugs and screening would make hepatitis C a rare disease by 2036, according to a computer simulation conducted by the University of Texas MD Anderson Cancer Center and the University of Pittsburgh Graduate School of Public Health. The results of the simulation are reported in the August 5 edition of the journal Annals of Internal Medicine.
"Hepatitis C (HCV) is the leading cause of liver cancer and accounts for more than 15,000 deaths in the U.S. each year," says Jagpreet Chhatwal, PhD, assistant professor of Health Services Research at MD Anderson, and corresponding author on the study.
"If we can improve access to treatment and incorporate more aggressive screening guidelines, we can reduce the number of chronic HCV cases, prevent more cases of liver cancer and reduce liver-related deaths," Chhatwal says.
HCV – a virus transmitted through the blood – is spread by sharing of needles, the use of contaminated medical equipment, and by tattoo and piercing equipment that has not been fully sterilized. Those at the highest risk for exposure are baby boomers – people born between 1945 and 1965. Widespread screening of the U.S. blood supply for hepatitis C began in 1992. A majority of people were infected through blood transfusions or organ transplants before 1992.
Baby boomers account for 75 percent of the estimated 2.7 to 3.9 million people infected in the United States. Half of people with the virus are not aware they are infected. The Centers for Disease Control and Prevention, and the U.S. Preventive Services Task Force now recommend a one-time HCV screening for this population group.
In this study, Chhatwal and his collaborators used a mathematical model with information from several sources including more than 30 clinical trials to predict the impact of new therapies called "direct-acting antivirals" and the use of screening for chronic HCV cases.
Researchers developed a computer model to analyze and predict disease trends from 2001 to 2050. The model was validated with historical data including a recently published national survey on HCV prevalence. Researchers predicted with new screening guidelines and therapies, HCV will only affect one in 1,500 people in the U.S. by 2036.
The model predicts one-time HCV screening of baby boomers would help identify 487,000 cases over the next 10 years.
"Though impactful, the new screening guideline does not identity the large number of HCV patients who would progress to advanced disease stages without treatment and could die," Chhatwal says.
"Making hepatitis C a rare disease would be a tremendous, life-saving accomplishment," says lead author Mina Kabiri, a doctoral student at the University of Pittsburgh Graduate School of Public Health. "However, to do this, we will need improved access to care and increased treatment capacity, primarily in the form of primary care physicians who can manage the care of infected people identified through increased screening."
In this study, researchers predicted a one-time universal screening could identify 933,700 HCV cases. Chhatwal and his colleagues also predict the universal screening and timely treatment can make HCV a rare disease in the next 12 years. Such screening can further prevent:
• 161,500 liver related deaths,
• 13,900 liver transplants and
• 96,300 cases of hepatocellular carcinoma – the most common type of liver cancer.
Chhatwal, whose current research focuses on evaluations of cancer prevention strategies using quantitative methods, says the availability of highly effective therapies and screening updates provide a great opportunity to tackle the hepatitis C epidemic. "But we need to ensure that we provide timely and affordable access to treatment to achieve the potential benefits."
"The new treatment that costs $1,000 a day has been a subject of debate and can become a barrier to timely access to all patients," Chhatwal says.
"Although recent screening recommendations are helpful in decreasing the chronic HCV infection rates, more aggressive screening recommendations and ongoing therapeutic advances are essential to reducing the burden, preventing liver-related deaths and eventually eradicating HCV," Chhatwal says.
The National Institutes of Health (KL2TR000146) funded this research.
Other researchers contributing to this study include Mark Roberts, MD, of the University of Pittsburgh Graduate School of Public Health; Alison Jazwinski, MD, of the University of Pittsburgh Medical Center, and Andrew Schaefer, PhD, of University of Pittsburgh Swanson School of Engineering