Assessing uncertainty in the burden of hepatitis C virus: Comparison of estimated disease burden and treatment costs in the UK

F. Gubay, R. Staunton, C. Metzig, I. Abubakar, Peter White*

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

2 Citations (Scopus)

Abstract

Hepatitis C virus (HCV) is a major and growing public health concern. We need to know the expected health burden and treatment cost, and understand uncertainty in those estimates, to inform policymaking and future research. Two models that have been important in informing treatment guidelines and assessments of HCV burden were compared by simulating cohorts of individuals with chronic HCV infection initially aged 20, 35 and 50 years. One model predicts that health losses (measured in quality-adjusted life-years [QALYs]) and treatment costs decrease with increasing initial age of the patients, whilst the other model predicts that below 40 years, costs increase and QALY losses change little with age, and above 40 years, they decline with increasing age. Average per-patient costs differ between the models by up to 38%, depending on the patients' initial age. One model predicts double the total number, and triple the peak annual incidence, of liver transplants compared to the other model. One model predicts 55%-314% more deaths than the other, depending on the patients' initial age. The main sources of difference between the models are estimated progression rates between disease states and rates of health service utilization associated with different disease states and, in particular, the age dependency of these parameters. We conclude that decision-makers need to be aware that uncertainties in the health burden and economic cost of HCV disease have important consequences for predictions of future need for care and cost-effectiveness of interventions to avert HCV transmission, and further quantification is required to inform decisions.

Original languageEnglish
Pages (from-to)514-523
Number of pages10
JournalJournal of Viral Hepatitis
Volume25
Issue number5
DOIs
Publication statusPublished - May 2018

Bibliographical note

Funding Information:
The authors thank the UK Department of Health (DH PRP 015/0306), EPSRC (EP/K026003/1), MRC (MR/K010174/1), NIHR Health Protection Research Unit in Modelling Methodology at Imperial College London in partnership with Public Health England (HPRU-2012-10080) and Public Health England, for funding. The funders had no role in study design, data collection and analysis, decision to publish or preparation of the manuscript. The views expressed are those of the authors and not necessarily those of the Department of Health, EPSRC, MRC, NHS, NIHR or Public Health England.

Funding Information:
The authors thank the UK Department of Health (DH PRP 015/0306), EPSRC (EP/K026003/1), MRC (MR/K010174/1), NIHR Health Protection Research Unit in Modelling Methodology at Imperial College London in partnership with Public Health England (HPRU-2012-10080) and Public Health England, for funding. The funders had no role in study design, data collection and analysis, decision to publish or preparation of the manuscript. The views expressed are those

Publisher Copyright:
© 2017 The Authors. Journal of Viral Hepatitis published by John Wiley & Sons Ltd.

Keywords

  • Markov model
  • disease burden
  • hepatitis C virus
  • uncertainty

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