The University of Texas MD Anderson Cancer Center and the University of Pittsburgh Graduate School of Public Health have conducted a computer simulation predicting that hepatitis C will be reduced to that of a rare disease by 2036 if effective new drugs and screening techniques are used. A full report on the results of the simulation was recently published in the journal Annals of Internal Medicine on August 5th.
“Hepatitis C (HCV) is the leading cause of liver cancer and accounts for more than 15,000 deaths in the U.S. each year,” said Jagpreet Chhatwal, Ph.D., assistant professor of Health Services Research at MD Anderson, and corresponding author on the study, adding that, “if we can improve access to treatment and incorporate more aggressive screening guidelines, we can reduce the number of chronic HCV cases, prevent more cases of liver cancer, and reduce liver-related deaths.”
HCV, a blood-transmitted virus, is easily spread by sharing needles, using contaminated medical equipment, and through inadequately sterilized tattoo and piercing equipment. People who were born between 1945 and 1965, often called “baby boomers,” are at the highest risk for exposure. Blood transfusions and organ transplants were responsible for infecting a majority of people before 1992, when widespread screening of blood supply for hepatitis C began in the U.S.
Of the estimated 2.7 to 3.9 million people infected in the United States, 75 percent are baby boomers. Since half of people with the virus do not know they are infected, the Centers for Disease Control and Prevention and the U.S. Preventive Services Task Force are now recommending that this population group be screened for HCV.
To perform this study, Chhatwal and his team utilized a mathematical model, processing information from a number of sources, including more than 30 clinical trials, in order to predict the impact of new therapies known as “direct-acting antivirals” as well as the use of screening for chronic HCV cases.
Researchers developed a computer model, validated with historical data including a recently published national survey on HCV prevalence, which analyzed and predicted disease trends from 2001 to 2050. They predicted that, with new screening guidelines and therapies, only one in 1,500 people in the U.S. will be affected by HCV in 2036.
The model also forecasts that 487,000 cases could be identified over the next 10 years through a one-time HCV screening of baby boomers.
“Though impactful, the new screening guideline does not identity the large number of HCV patients who would progress to advanced disease stages without treatment and could die,” Chhatwal said.
“Making hepatitis C a rare disease would be a tremendous, life-saving accomplishment,” said Mina Kabiri, a doctoral student at the University of Pittsburgh Graduate School of Public Health and lead author of the study. “However, to do this, we will need improved access to care and increased treatment capacity, primarily in the form of primary care physicians who can manage the care of infected people identified through increased screening.”
Researchers involved in this study predicted that a one-time universal screening could identify 933,700 HCV cases. They also forecast that the universal screening and timely treatment can render HCV a rare disease in 12 years. Universal screening would also prevent: 161,500 liver-related deaths, 13,900 liver transplants as well as 96,300 cases of hepatocellular carcinoma, which is the most common type of liver cancer.
Chhatwal, who currently focuses on evaluations of cancer prevention strategies using quantitative methods, states that currently available therapies, together with screening updates, provide a magnificent opportunity to take on the hepatitis C epidemic. “But we need to ensure that we provide timely and affordable access to treatment to achieve the potential benefits.”
“The new treatment that costs $1,000 a day has been a subject of debate and can become a barrier to timely access to all patients,” Chhatwal said, referring to Sovaldi, Gilead’s recent breakthrough drug for Hepatitis C that sparked debate over drug pricing with its $84,000 per treatment course price tag.
“Although recent screening recommendations are helpful in decreasing the chronic HCV infection rates, more aggressive screening recommendations and ongoing therapeutic advances are essential to reducing the burden, preventing liver-related deaths and eventually eradicating HCV,” Chhatwal concluded.
Other researchers contributing to this study, funded by the National Institutes of Health, include Mark Roberts, M.D. of the University of Pittsburgh Graduate School of Public Health; Alison Jazwinski, M.D. of the University of Pittsburgh Medical Center, and Andrew Schaefer, Ph.D. of University of Pittsburgh Swanson School of Engineering.