Table of Contents Author Guidelines Submit a Manuscript
Canadian Journal of Gastroenterology and Hepatology
Volume 28, Issue 5, Pages 243-250
http://dx.doi.org/10.1155/2014/317623
Original Article

Burden of Disease and Cost of Chronic Hepatitis C Virus Infection in Canada

Robert P Myers,1 Mel Krajden,2 Marc Bilodeau,3 Kelly Kaita,4 Paul Marotta,5 Kevork Peltekian,6 Alnoor Ramji,7 Chris Estes,8 Homie Razavi,8 and Morris Sherman9

1Liver Unit, Division of Gastroenterology and Hepatology, Department of Medicine, University of Calgary, Calgary, Alberta, Canada
2BC Centre for Disease Control, Vancouver, British Columbia, Canada
3University of Montreal, Montreal, Quebec, Canada
4University of Manitoba, Winnipeg, Manitoba, Canada
5Western University, London, Ontario, Canada
6Dalhousie University, Halifax, Nova Scotia, Canada
7University of British Columbia, Vancouver, British Columbia, Canada
8Center for Disease Analysis, Louisville, Colorado, USA
9University of Toronto, Toronto, Ontario, Canada

Received 6 March 2014; Accepted 2 April 2014

Copyright © 2014 Hindawi Publishing Corporation. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

BACKGROUND: Chronic infection with hepatitis C virus (HCV) is a major cause of cirrhosis, hepatocellular carcinoma and liver transplantation.

OBJECTIVE: To estimate the burden of HCV-related disease and costs from a Canadian perspective.

METHODS: Using a system dynamic framework, the authors quantified the HCV-infected population, disease progression and costs in Canada between 1950 and 2035. Specifically, 36 hypothetical, ageand sex-defined cohorts were tracked to define HCV prevalence, complications and direct medical costs (excluding the cost of antivirals). Model assumptions and costs were extracted from the literature with an emphasis on Canadian data. No incremental increase in antiviral treatment over current levels was assumed, despite the future availability of potent antivirals.

RESULTS: The estimated prevalence of viremic hepatitis C cases peaked in 2003 at 260,000 individuals (uncertainty interval 192,460 to 319,880), reached 251,990 (uncertainty interval 177,890 to 314,800) by 2013 and is expected to decline to 188,190 (uncertainty interval 124,330 to 247,200) in 2035. However, the prevalence of advanced liver disease is increasing. The peak annual number of patients with compensated cirrhosis (n=36,210), decompensated cirrhosis (n=3380), hepatocellular carcinoma (n=2220) and liver-related deaths (n=1880) are expected to occur between 2031 and 2035. During this interval, an estimated 32,460 HCV-infected individuals will die of liver-related causes. Total health care costs associated with HCV (excluding treatment) are expected to increase by 60% from 2013 until the peak in 2032, with the majority attributable to cirrhosis and its complications (81% in 2032 versus 56% in 2013). The lifetime cost for an individual with HCV infection in 2013 was estimated to be $64,694.

CONCLUSIONS: Although the prevalence of HCV in Canada is decreasing, cases of advanced liver disease and health care costs continue to rise. These results will facilitate disease forecasting, resource planning and the development of rational management strategies for HCV in Canada.