- Hello, Jeff -
- Below is estimated projection for future morbidity and
mortality and costs for HCV in the US. Remember, the study does not take
into consideration the immigrants that are arriving illegally as we speak.
Many of these folks are infected with diseases and many with HCV as well
as HIV. HCV is far more infectious then HIV.
- As many of the illegals are indigent the cost of their
treatment will eventually be "footed" by (none other then) the
- It also does not take into consideration the babies who
will be born to HCV infected mothers and who will eventually also be found
to have HCV.
- Note the cost for liver transplantation. Staggering.
- People do not realize that we have a major epidemic,
in fact, a pandemic of HCV and it will touch each and every one of us,
either by the taxes to pay for treatments, higher medical costs and/or
losses of friends and loved one to the disease.
- The study only projects future HCV costs and cases on
the basis of already diagnosed cases. If we calculate in all of the non-diagnosed
cases the projection will be even more catastrophic.
- I believe that we are now seeing more and more younger
people, young adults and teens diagnosed with HCV.
- If these stats represented a biological terrorist event,
the population would demand that the government do something about the
outbreak. I don't hear the public demanding better infection control or
demand more research into new treatment for HCV. The status quo treatment
is interferon or combo of and, eventually, liver transplant. In my opinion,
the treatment is futile and a tremendous drain on the health of those taking
the treatment. I do not believe this treatment works. If the numbers of
cases continues to grow, the projection in the study below will be far
less then the actual numbers of cases, deaths and cost in dollars.
- Thank you,
- Patricia Doyle
- Estimating future hepatitis C morbidity, mortality, and
costs in the United States
- This study estimated future morbidity, mortality, and
costs resulting from hepatitis C virus (HCV). We used a computer cohort
simulation of the natural history of HCV in the US population.
- From the year 2010 through 2019, our model projected
165,900 deaths from chronic liver disease, 27,200 deaths from hepatocellular
carcinoma, and $10.7 billion in direct medical expenditures for HCV. During
this period, HCV may lead to 720,700 years of decompensated cirrhosis and
hepatocellular carcinoma and to the loss of 1.83 million years of life
in those younger than 65 at a societal cost of $21.3 and $54.2 billion,
respectively. In sensitivity analysis, these estimates depended on (1)
whether patients with HCV and normal transaminase levels develop progressive
liver disease, (2) the extent of alcohol ingestion, and (3) the likelihood
of dying from other causes related to the route of HCV acquisition.
- Our projections for hepatitis C likely underestimated
the long-term costs be-cause they did not include future expenses related
to periodic liver biopsy, screening for hepatocellular carcinoma, and treatment
costs. Moreover, our estimates applied variable costs (the additional cost
to treat 1 more patient) and not charges (retail price) or total costs
(including fixed costs or overhead). The latter are typically 2 to 3 times
higher. For example, in this analysis, liver transplantation cost $108,659
for the first year and $18, 976 per year subsequently (in 1999 dollars),
but other studies that used charge data reported transplantation costs
of $200,000 or higher for the surgery and $25,000 per year for medications.
- Our estimates did not consider the possibility of accelerated
HCV progression in older individuals or those co-infected with hepatitis
B or HIV, who are more likely to develop hepatic complications.
- Based on the 2 million individuals who had detectable
viral RNA for HCV and who presumably had elevated liver transaminases in
1991, our model predicted that annual HCV-related liver deaths for the
years 2010 to 2019 would increase 2-fold when compared with the 8000 deaths
in 1991. HCV-related chronic liver disease mortality would be 181,300 over
this 10-year period, with another 27,200 deaths from HCV-related hepatocellular
carcinoma. The highest proportion of deaths related to hepatitis C would
occur 10 to 20 years from now, peaking in 2014. The need for liver transplants
would rise until 2015. Because of the higher risk for decompensated liver
disease and the relatively low risk of cancer assumed for this analysis,
new cases of hepatocellular carcinoma would rise only until 2008 but would
remain relatively stable throughout the next 20 years, varying by at most
several hundred. Figure 3 shows the estimated annual direct medical care
costs. For the 10-year period from 2010 to 2019, direct medical expenditures
would be $10.7 billion.
- Our results confirm prior Centers for Disease Control
and Prevention projections and suggest that HCV may lead to a substantial
health and economic burden over the next 10 to 20 years.
- Our results suggested that despite the remarkable decline
in the incidence of hepatitis C, mortality related to existing cases of
hepatitis C in 1991 will likely continue to increase over the next 10 to
20 years, and our results confirmed that hepatitis C may be an awakening
giant. Although screening tests and treatments are available, waiting times
for new patient appointments to see a hepatologist for evaluation of hepatitis
C in some parts of the United States have increased to several months,
emphasizing the need to train clinicians in the management of hepatitis
C. There is some urgency for action because hepatitis C is frequently asymptomatic
until cirrhosis develops, at which time treatment is less effective. Once
hepatic decompensation occurs, treatment is limited by the shortage of
donor transplant organs. Additional research regarding the cost-effectiveness
of screening for hepatitis C and indications for treatment should be pursued
to help formu-late public health policy in this area. Continued research
on the natural history of he-patitis C and the development of new treatments
should remain priorities for the nationÕs health.
- American Journal of Public Health, Vol 90, Issue 10 1562-1569
JB Wong, GM McQuillan, JG McHutchison and T Poynard Department of Medicine,
New England Medical Center, Tupper Research Institute, Tufts University
School of Medicine, Boston, Mass., USA.
- EFFECT OF TREATMENT MANAGEMENT ALGORITHMS ON RIBAVIRIN
AND PEGINTERFERON ALFA-2B COSTS FOR CHRONIC HEPATITIS C
- AASLD, Nov 2002
- Peginterferon alfa-2b and ribavirin have the highest
sustained response rates for chronic hepatitis C but published drug cost
estimates usually assume full dosing for 48 weeks. These estimates neglect
dose reductions and discontinuations that occur during treatment as well
as clinical management algorithms that lead to drug stoppage in those unlikely
to benefit from further therapy.
- The aim of this study is to estimate the antiviral drug
costs associated with peginterferon alfa-2b+ribavirin. We analyzed actual
drug dosing for 511 patients who were intended to receive 800 mg of ribavirin
daily and 1.5 mcg/kg peginterferon alfa-2b weekly (PegR8) for 48 weeks
and for the subset receiving 10.6 mg/kg of ribavirin (PegRW) (Manns Lancet).
Based on ribavirin capsules and peginterferon vials used in this trial,
we determined the drug costs for 1) full dosing (Full), 2) intent to treat
with reductions and discontinuations as occurred in the trial (ITT), 3)
discontinuing therapy in those who were HCV RNA-positive after 24 weeks
(Stop24), 4) criteria in Stop24 and also limiting therapy in those with
genotype 2/3 to 24 weeks (Stop2/3), and 5) criteria in Stop2/3 and also
discontinuing therapy in those viral positive or with 2 log drop in viral
load in non-genotype 2/3 patients after 12 weeks (Stop12). Any missing
PCR values were assumed to be positive.
- The table shows the drug costs for both regimens and
shows that these management algorithms result in substantial reductions
in likely drug costs. Checking a qualitative PCR at week 24 would allow
discontinuation in the 31-36% of patients who are unlikely to respond with
further therapy. If the duration of therapy is also limited to 24 weeks
for those with genotype 2/3, in all, 60-61% may stop therapy after 24 weeks.
Checking a qualitative and a quantitative PCR at week 12 and discontinuing
therapy for those PCR positive with <2 log decrease in viral load would
allow stopping therapy for 23-24% of patients at week12. Because most genotype
2/3 patients respond by 12 weeks, also applying the same Stop12 rule for
those with genotype 2/3 would only increase drug stoppage at week 12 to
24-26% of all patients. Although the goal was 48 weeks of treatment, the
overall observed ITT mean duration of therapy was 42 weeks. Alternative
management algorithms would decrease the overall mean duration of therapy
for all patients to 37 weeks with Stop24, 31 weeks with Stop2/3 and 29
weeks with Stop12. For the 61-62% of patients affected by these treatment
management algorithms, the observed mean 40 week therapy duration with
ITT would be reduced to 31-32 weeks with Stop24, 21 weeks with Stop2/3
and 18-19 weeks with Stop12.
- Our results suggest that treatment management algorithms
substantially reduce antiviral drug costs and the duration of therapy.
Drug costs should be weighed against the cost and likelihood of complications
from hepatitis C and should consider therapeutic effectiveness. Individual
decisions to continue ribavirin and peginterferon alfa-2b should also consider
the potential clinical benefits for specific patient characteristics, such
as advanced fibrosis.
- John B Wong, Tufts-New England Medical Center, Boston,
MA; Gary L Davis, Baylor University Medical Center, Dallas, TX; John G
McHutchison, Scripps Clinic, La Jolla, CA; Michael P Manns, Medizinische
Hochschule Hannover, Hannover, Germany; Janice K Albrecht, Schering-Plough
Research Institute, Kenilworth, NJ
- Patricia A. Doyle, PhD
- Please visit my "Emerging Diseases" message
- Zhan le Devlesa tai sastimasa
- Go with God and in Good Health