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Liver Disease Expected to Increase in Switzerland Over Time

The hepatitis C virus infection burden in Switzerland is expected to increase through the year 2030 due to more patients developing advanced liver disease related to the infection, according to published findings.

Researchers in Switzerland used a model previously developed by Homie A. Razavi, of the Center for Disease Analysis in Louisville, CO, and colleagues, which showed HCV progression and mortality over time. The model was a disease progression model constructed in Microsoft

Excel (Microsoft Corp.) that quantified the size of the HCV-infected population, according to liver disease stage, through 2030.

“The model [we used] was populated and calibrated using Swiss specific assumptions to forecast the future burden of HCV by stage of the disease,” the researchers wrote. “For consistency, the HCV population by sequelae in 2030 was used for comparison to the 2013 populations. … Model outcomes included annual estimates of total viremic infections as well as viremic infections by disease sequelae. Deaths attributable to background mortality and liver related mortality were also tracked annually.”

The model showed that the peak viremic prevalence of chronic HCV reached 88,600 cases in 2003 and decreased to 82,700 by 2013. However, the researchers found that the number of advanced cases of liver disease were expected to increase through 2030, despite this decrease in viremic HCV.

“Although prevalence was estimated to decline to 63,200 viremic infections in 2030, assuming that all inputs and outputs remain stable over time [including treatment uptake and efficacy] the number of individuals with advanced liver disease increased,” the researchers wrote.

According to the model, the number of cases of compensated cirrhosis (n = 12,700) was projected to increase by 50%; decompensated cirrhosis (n = 1,790) to increase by 57%; and hepatocellular carcinoma (n = 745) to increase by 84% compared to the 2013 populations. Additionally, by 2030, liver-related death was projected to increase by 72% (380 to 650) as the HCV population grew older, according to the researchers.

In terms of cost, the 2013 annual health care cost to treat viremic HCV, which did not include antiviral treatment costs, was estimated to be 74 million euros. In 2030, the annual cost was projected to reach a peak of 97 million euros. Overall, the cumulative healthcare costs from 2013 to 2030 was projected to reach 1,581 million euros.

If treatment for viremic HCV was not used or discontinued, the prevalence was expected to decrease at a “slower rate than under the base case, with 73,400 viremic cases in 2030,” according to the researchers. However, the number of cases of compensated cirrhosis and decompensated cirrhosis were projected to increase to 16,485 and 2,280 cases, respectively, by 2030. Also, the number of cases of patients developing HCC due to HCV was projected to increase by 22% by 2030 and liver-related mortality was also projected to increase from 380 deaths in 2013 to 800 deaths in 2030, “a 23% increase over the base case,” according to the researchers.

Discontinuing treatment was associated with a projected 190 million euros per year increase in net costs from 2013 to 2030 when compared with the base case. The increase was due to the progression to advanced disease by those who would have been cured under the base scenario.

“In 2030, annual costs were projected to be 24% higher than under the base case,” the researchers wrote.

To achieve a 90% decrease in mortality rate, while still limiting access of treatment to patients with fibrosis stage greater than 2, an increase in treatment of up to 4,190 patients annually by 2018, would be required. This would also need to include 95% of the treatments being sustained virologic response therapies, according to the study.

“Despite a decrease in the rate of new infections in Switzerland, HCV poses a considerable public health threat caused by secondary liver related morbidity and mortality of those already infected,” the researchers wrote. “This is further complicated by the fact that less than 50% of the infected population is aware of their infection.”

The researchers concluded: “In order to improve detection and treatment of HCV, Switzerland needs to coordinate its efforts nationwide. … Further modeling analyses are needed to evaluate the cost effectiveness of these aforementioned strategies, including the cost of medication. The analysis presented here highlights the need to develop timely strategies to reduce the effects of chronic HCV disease in Switzerland.” – by Melinda Stevens

Disclosures: Müllhaupt reports serving as an advisory board member for Roche, MSD, Janssen Therapeutics, AbbVie, Boehringer Ingelheim, Gilead Sciences and Bristol-Myers Squibb; and has served as a consultant for Gilead Sciences and AbbVie; and received research grants from Roche and Gilead Sciences. Please see the full study for a list of all other authors’ relevant financial disclosures.