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Volume 77 - 2014 - Fasc.2 - Position paper

Perspective editorial Innovative strategies for hepatitis C in Belgium integrating treatment efficacy, public disease burden, and healthcare costs

Hepatitis C is a leading cause of chronic liver disease, end-stage cirrhosis and liver cancer worldwide (1). Thus far, the standard of care approved for hepatitis C in -Belgium-shows-relatively-limited-efficacy-and-is-usually associated with serious, not always reversible side ef- fects. As a consequence, patients who are of utmost need for therapy are often not eligible for these treatments. A number of new generation therapies with extremely high efficacy- and- a- good- safety- profile- are- in- the- pipeline-(2) which likely will revolutionize (near) future HCV treatment. SO. gaining good insight into the health-, eco- nomic- and societal burden associated with HCV and its sequelae is of key importance to appropriately assess the value of these new innovative treatments(2,4). As Belgium has been found to lag behind with respect to HCV disease detection and treatment, the Belgian Working Group on HCV aimed to contribute to a better understanding of the burden associated with HCV infec- tion in Belgium through assessing HCV-related preva- lence and attributable mortality, and through assessing the health and economic impact using different innova- tive scenarios of diagnosis and treatment rates (5-7). The development of public health strategies will allow us to predict the global impact of new treatment and preven- tion initiatives, all correctly informing health policy.


Hepatitis C Epidemiology in Belgium

Background : The burden of hepatitis C virus (HCV) infection is significant and is increasing with the aging population. The results of a modeling study that included Belgium, along with many other countries, was published in April 2014. An in depth discussion sur- rounding the epidemiology of HCV in Belgium will be presented here. Methods : A systematic literature review was conducted to assess the historical and current clinical burden of HCV in Belgium. Two expert panels were convened to discuss the strengths and limita- tions surrounding the available data and to generate consensus re- garding the best estimates for total number of HCV cases, number of cases diagnosed, and the number of patients treated and cured, including potential HCV control strategies. Results : Although no national studies exist, there were an esti- mated 70,000 (10,000-91,000) viremic HCV infections in 1994. By 2010 there were an estimated 22,900 individuals diagnosed with viremic HCV, and in 2011 approximately 710 patients were treated annually. An estimated 13% of liver transplants were attributable to HCV in 2011. Genotype 1 predominated (59%), followed by genotypes 3 (19%) and 4 (14%). Conclusions : Estimates of HCV prevalence, diagnosed cases and liver transplants due to HCV were available through published studies. However these publications were subject to bias and were occasionally outdated. Improved estimates of HCV prevalence would be useful for informing treatment, prevention and policy efforts in Belgium. (Acta gastroenterol. belg., 2014, 77, 277-279).


The Disease Burden of Hepatitis C in Belgium : development of a realistic disease control strategy

Background : Novel direct antiviral agents (DAAs) will become available soon with higher sustained viral response (SVR), fewer side-effects and higher compliance. Our aim was to evaluate differ- ent realistic strategies to control the projected increase in HCV- related disease burden in Belgium. Methods : Based on literature review, expert opinions and his- torical assumptions, HCV-disease progression and mortality in Belgium was modeled to 203O.Strategies exploring the impact of increased treatment, treatment delay, and treatment restrictions were developed. Results : Although the overall HCV prevalence is decreasing in Belgium, the burden of advanced stage HCV, including cirrhosis and hepatocellular carcinoma (HCC), is expected to increase under current treatment and cure rates. By increasing SVR to 90% from 2016 onward and the number of treated cases (from 710 to 2,050), in 2030 the cases with cirrhosis, decompensated cirrhosis and HCC would be significantly lower than in 2013. This strategy was found most efficient when applied to F2-F4 cases. To obtain comparable outcomes with F0-F4 cases, 3,490 patients should be treated. A two year delayed access to the DAAs increased HCV related morbidity and mortality by 15% relative to our strategy. Conclusions : Considering the evolving burden of HCV disease and the need for efficacious usage of healthcare resources, primary application of new DAAs in Belgium should focus on patients with significant and advanced fibrosis (F2-F4), providing these new drugs without delay upon availability and increasing access to therapy. (Acta gastroenterol. belg., 2014, 77, 280-284).


Current and future health and economic impact of hepatitis C in Belgium

Background and study aims : Chronic hepatitis C virus (HCV) infection is a serious global health problem affecting 150 million individuals worldwide. Although infection rates are decreasing, an aging population with progressing disease is expected to result in increased burden of advanced stage disease with high associated costs. This analysis describes the current and projected future economic impact of HCV sequelae in Belgium. Methods : A previously described and validated model was pop- ulated with Belgian inputs and calibrated to project the current and future health and economic burden of HCV. Monte Carlo and sensitivity analyses were run to quantify uncertainty. All estimates exclude the cost of antiviral therapy. Results : Costs associated with HCV were projected to peak in 2026 at €126M (€30M-€257M), while decompensated cirrhosis and hepatocellular carcinoma costs were projected to increase until 2031 and 2034. The projected 2014-2030 cumulative cost of HCV under current conditions was €1,850M. Scenarios to reduce the burden of HCV could result in €70M-€400M in cumulative cost savings. Starting treatment (1,000 patients) in 2015 could result in €150M cost savings. The lifetime cost of HCV increases with life expectancy, with highest future costs projected among young females with early stage disease. Conclusions : The economic burden of HCV and advanced stage disease were projected to further increase. Cost reductions are possible with timely interventions aimed at minimizing the health burden of advanced stage disease. (Acta gastroenterol. belg., 2014, 77, 285-290).