Managed Care Outlook

Hepatitis C meets its match

Exciting news about treating hepatitis C (HCV) keeps on coming. For instance, it could be classified a rare disease by 2036 (and, in a best-case scenario, by 2026) thanks to new therapies and more aggressive treatment, according to a study in Annals of Internal Medicine.

‘Recently approved therapies for HCV infection and one-time birth-cohort screening could prevent approximately 124,000 cases of decompensated cirrhosis, 78,800 cases of hepatocellular carcinoma, 126,500 liver-related deaths, and 9,900 liver transplantations by 2050,’ according to the study, The Changing Burden of Hepatitis C Virus Infection in the United States: Model-Based Predictions. (The birth-cohort screening is important because three quarters of those infected with HCV in the United States were born between 1945 and 1965.)

The number of new HCV infections has been dropping anyway, from 3.2 million in 2001 to 2.3 million in 2013. That’s just the slow start, researchers say. They note just how quickly treatment evolves, citing the launch of direct-acting antivirals (DAAs) in 2011 and the one-time birth-cohort screening begun in 2013.

Researchers estimated how HCV will advance under four models. A natural-history scenario simulated HCV advances with no screening and no treatment. A pre-DAA model told the story minus the introduction of DAAs. The base-case model included risk-based and birth-cohort screening. In the ideal scenario, everybody would be screened and those needing treatment get it. In such a scenario, HCV infection becomes a rare disease by 2026. Base-case and ideal scenarios are illustrated below.

Base case scenario vs. ideal scenario: the difference that direct-acting antivirals, universal screenings, and unlimited treatment could make

Liver-related deaths
Hepatocellular carcinoma
Decompensated cirrhosis
Liver transplants

Source: Kabiri M, et al. Ann Intern Med. 2014 Aug 5;161(3):170–180.


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