Forecasting the morbidity and mortality associated with prevalent cases of pre-cirrhotic chronic hepatitis C in the United States

Dig Liver Dis. 2011 Jan;43(1):66-72. doi: 10.1016/j.dld.2010.05.006. Epub 2010 Jun 17.

Abstract

Background: Without diagnosis and antiviral therapy, many patients with chronic hepatitis C infections will develop end-stage liver disease and die from complications.

Aims: To evaluate the future impacts of preventive interventions and treatment advances, this paper forecasts a baseline estimate of the future morbidity and mortality of prevalent hepatitis C when left untreated.

Methods: We simulated the future disease progression and death for all Americans with prevalent hepatitis C in 2005. To validate the model, we used past seroprevalence to forecast contemporary outcomes. We used the validated model to forecast future cases of end-stage liver disease, transplants, and deaths from 2010 to 2060, and we estimated credible intervals using Monte Carlo simulation.

Results: When programmed with past data, our model predicted current levels of hepatitis C outcomes with accuracy between ±1% and 13%. Morbidity and mortality from hepatitis C will rise from 2010 to a peak between the years 2030 and 2035. We forecasted a peak of 38,600 incident cases of end-stage liver disease; 3200 referrals for transplant; and 36,100 deaths.

Conclusions: Because current rates of screening and treatment are low, future morbidity and mortality from hepatitis C are likely to increase substantially without public health interventions to increase treatment.

Publication types

  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • Adult
  • Asymptomatic Infections / epidemiology*
  • Asymptomatic Infections / mortality
  • Computer Simulation
  • Disease Progression
  • End Stage Liver Disease / epidemiology*
  • End Stage Liver Disease / mortality
  • Female
  • Forecasting*
  • Hepatitis C, Chronic / epidemiology*
  • Hepatitis C, Chronic / mortality
  • Humans
  • Liver Transplantation / trends*
  • Male
  • Markov Chains
  • Middle Aged
  • Models, Theoretical
  • Monte Carlo Method
  • Morbidity / trends
  • United States / epidemiology
  • Young Adult