Hepatitis C on Track to Become a Rare Disease by 2036

Screening of newborn children for hepatitis C and new, more effective hepatitis C treatments may virtually eliminate the disease in the United States by 2036.

In the United States, hepatitis C virus (HCV) is the source of considerable health expenditures in the form of chronic liver disease and hepatocellular carcinoma, accounting for an estimated $6.5 billion in expenditures in 2011 alone.^1,2

Fortunately, according to researchers at the Division of Gastroenterology, Hepatology and Nutrition at the University of Pittsburgh in Pennsylvania, the combination of screening initiatives and the availability of direct-acting antivirals such as Sovaldi and Olysio may change the future of HCV. Although HCV remains a common disease, affecting an estimated 2.3 million individuals in the United States alone as of 2013, that number of patients is down from 3.2 million cases in 2001.¹

Authors modeled the influence of a recommendation from the Centers for Disease Control and Prevention and the United States Preventive Services Task Force to expand screening for all people born between 1945 and 1965 (baby boomers).^1,3,4

To model the future of HCV, investigators estimated the effect of 1-time screening of both baby boomers, along with 1-time screening of children at birth. The authors also accounted for the increased efficacy of antiviral treatments, and based the model on data collected by the National Health and Nutrition Examination Survey between 1999 and 2002.¹

Over the next 10 years, with implementation of 1-time screening of newborns, investigators estimate that 487,000 cases of HCV infection may be identified and treated. According to investigators, universal screening of all adults would identify 933,700 cases of HCV over the same 10-year period, although universal screening was not a prerequisite of the investigators’ model.¹

By 2036, the combination of 1-time screening at birth and use of direct-acting antivirals is expected to transform HCV from the relatively common disease it is today to a rare disease, affecting 1 person in every 1500. Several sensitivity analyses were conducted, all of which predict virtual elimination of HCV by the year 2050.¹

It is important to remember that these optimistic predictions hinge on implementation of recommendations, including coverage and implementation of screening recommendations. With the availability of new, effective medications that act directly against HCV, dramatic reductions in the prevalence of the disease and its eventual eradication are a strong possibility in the future.

References:

• Razavi H, Elkhoury AC, Elbasha E, et al. Chronic hepatitis C virus (HCV) disease burden and cost in the United States. Hepatology. 2013;57(6):2164-2170.
• Kabiri M, Jazwinski AB, Roberts MS, Schaefer AJ, Chhatwal J. The changing burden of hepatitis C virus infection in the United States: model-based predictions. Ann Intern Med. 2014;161(3):170-180.
• Moyer VA; U.S. Preventive Services Task Force. Screening for hepatitis C virus infection in adults: U.S. Preventive Services Task Force recommendation statement. Ann Intern Med. 2013;159(5):349-357.
• Smith BD, Morgan RL, Beckett GA, et al. Recommendations for the identification of chronic hepatitis C virus infection among persons born during 1945-1965. MMWR Recomm Rep. 2012.