Burden of Hepatitis C Infection: Realities and Challenges

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FULL TEXT: http://www.medscape.com/viewarticle/584515

From Medscape Gastroenterology

Hepatitis C Expert Column

Burden of Hepatitis C Infection: Realities and Challenges

Posted 12/04/2008

Hashem B. El-Serag, MD, MPH

Burden of Disease

" Burden of disease " is a term that captures the frequency of the disease (such

as the incidence and prevalence) as well as how it affects other aspects of the

health of a population. This may include the negative impact of disease on

longevity (such as premature death and years of lost life), morbidity (pain and

impaired health-related quality of life), and economic consequences of the

disease (such as direct healthcare expenditures in caring for the disease and

indirect costs related to lost income from premature death or disability).

Therefore, one needs to take all of these aspects into account in order to

understand the true magnitude of a disease's burden. Such understanding is also

essential in formulating healthcare policies to prioritize health interventions

and to allocate scarce resources across a range of medical diseases. For

example, expensive interventions (eg, new treatments for hepatitis C virus [HCV]

infection) will add cost and therefore may increase the disease burden; however,

these interventions may actually reduce the overall disease burden by prolonging

life and improving quality of life.

Chronic infection with HCV is a major cause of liver-related morbidity and

mortality. An estimated 180 million people worldwide, including 4 million in the

United States, are infected with the virus.[1] In the United States, end-stage

liver disease due to chronic hepatitis C is the most common indication for liver

transplantation,[2] and markers for the virus have been found in at least half

of all cases of hepatocellular carcinoma (HCC).[3,4] HCV infection is postulated

to result in an 8- to 12-year reduction in overall life expectancy in infected

individuals, as well as in reduced health-related quality of life.[5]

As the screening, diagnosis, and treatment of HCV infection continues to evolve

with the availability of more effective yet more costly treatments, the cost of

care will continue to rise. However, this increasing cost of care may still be

acceptable and justifiable if it results in an accompanying improvement in

quality-adjusted life years (ie, if it is cost-effective).