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Assessing uncertainty in the burden of Hepatitis C Virus: comparison of estimated disease burden and treatment costs in the UK

Gubay, F; Staunton, R; Metzig, C; Abubakar, I; White, PJ; (2018) Assessing uncertainty in the burden of Hepatitis C Virus: comparison of estimated disease burden and treatment costs in the UK. Journal of Viral Hepatitis , 25 (5) pp. 514-523. 10.1111/jvh.12847. Green open access

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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 policy-making 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 utilisation 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.

Type: Article
Title: Assessing uncertainty in the burden of Hepatitis C Virus: comparison of estimated disease burden and treatment costs in the UK
Open access status: An open access version is available from UCL Discovery
DOI: 10.1111/jvh.12847
Publisher version: https://doi.org/10.1111/jvh.12847
Language: English
Additional information: Copyright © 2017 The Authors. Journal of Viral Hepatitis published by John Wiley & Sons Ltd. This is an open access article under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/ by/4.0/), which permits use, distribution and reproduction in any medium, provided the original work is properly cited.
Keywords: Markov model, disease burden, hepatitis C virus, uncertainty
UCL classification: UCL
UCL > Provost and Vice Provost Offices
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Population Health Sciences
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Population Health Sciences > Institute for Global Health
URI: https://discovery.ucl.ac.uk/id/eprint/10042181
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