Projections of Hepatitis C and Advanced Liver Disease

San Diego—Between 2008 and 2015, the number of patients with advanced liver disease is expected to increase from 195,000 to 601,000, with people born from 1945 to 1964 representing >75% of the cases, according to a study of adjudicated Medicare and commercial medical claims data.

 Results were presented during a poster session at DDW. The poster was titled Current and Future Disease Progression of HCV-Infected Patients Among Different Age Cohorts.

Patients with chronic hepatitis C can eventually have advanced liver disease such as cirrhosis, decompensated cirrhosis, and liver cancer or transplantation. Within 20 to 30 years of initial infection, approximately 20% of patients with hepatitis C develop cirrhosis.

The authors analyzed prevalence and diagnosis rates from the National Health and Nutrition Evaluation Surveys (NHANES) from 2005-06 and 2007-08 and the 2007-09 Medicare claims database.

To calculate disease progression rates, the authors utilized the IMS LifeLink database from 2007 through 2009. They used the patient status in 2007 to determine if they were newly diagnosed or existing, and all undiagnosed patients in 2008 were considered as not having advanced liver disease. The authors noted patients progress to more severe complications except for those with decompensated cirrhosis, who may revert to cirrhosis.

In 2008, an estimated 3.57 million people in the United States had hepatitis C. Of the patients, 75.1% (2.68 million) were chronically infected, although only 1.10 million were diagnosed with the disease. People born from 1945 to 1964 accounted for 75.6% of patients diagnosed with hepatitis C, while 16.2% were <45 years of age and 8.3% were ≥65 years of age.

Of the 1.10 million people diagnosed with hepatitis C, 195,000 (17.7%) had advanced liver disease: 9.1% of patients <45 years of age who were diagnosed with hepatitis C had advanced liver disease compared with 17.0% of patients from 45 to 54 years of age, 22.2% of patients from 55 to 64 years of age, and 18.8% of patients ≥65 years of age. People born from 1945 to 1964 represented 83.0% of those diagnosed with advanced liver disease.

The authors also found that approximately 5% of patients who do not have advanced liver disease progress to advanced liver disease annually, while >10% of patients with advanced liver disease progress to more advanced disease each year.

Further, patients with cirrhosis (the mildest form of advanced liver disease) had higher mortality rates than those who do not have advanced liver disease regardless of age. As the severity of advanced liver disease increased, the mortality rates increased. The all-cause mortality rates were highest in patients with decompensated cirrhosis and liver cancer.

In addition, the authors estimated 298,000 of patients who had hepatitis C in 2008 but were undiagnosed will progress to have advanced liver disease in 2015, while an additional 108,000 patients who were diagnosed with hepatitis C will have advanced liver disease by 2015. Of the patients with advanced liver disease in 2015, the majority will have cirrhosis or decompensated cirrhosis.

Among the complications cited, the study only included data from 2007 to 2009, so the authors could not determine if there was a cause between hepatitis C and the presence of an advanced liver disease complication. The authors also mentioned progression rates may have included treated patients because they derived the rates from the diagnosed hepatitis C cohort.—Tim Casey

This study was supported by Vertex Pharmaceuticals.