Hepatitis C in Lebanon: the burden of the disease and the value of comprehensive screening and treatment
Received 20 December 2017
Accepted for publication 26 April 2018
Published 28 August 2018 Volume 2018:10 Pages 73—85
Checked for plagiarism Yes
Review by Single-blind
Peer reviewer comments 3
Editor who approved publication: Dr Gerry Lake-Bakaar
Antoine Abou Rached,1 Selim Abou Kheir,1 Jowana Saba,1 Salwa Assaf,2 Georges Kassis,3 Yuri Sanchez Gonzalez,4 Olivier Ethgen5,6
1Faculty of Medicine, School of Medicine, Lebanese University, Beirut, Lebanon; 2Abbvie Biopharmaceuticals GmbH, Beirut, Lebanon; 3Abbvie Biopharmaceuticals, Paris, France; 4AbbVie Inc., North Chicago, IL, USA; 5SERFAN Innovation, Namur, Belgium; 6Department of Public Health, Epidemiology and Health Economics, University de Liège, Liège, Belgium
Purpose: To analyze the hepatitis C virus (HCV) burden in Lebanon and the value of comprehensive screening and treatment for different age groups and fibrosis stages.
Methods: We used a multicohort, health-state-transition model to project the number of HCV genotype 1 and 4 patients achieving a sustained virologic response 12 weeks after treatment or progressing to compensated cirrhosis (CC), decompensated cirrhosis (DCC), hepatocellular carcinoma (HCC), or liver-related death (LrD) from 2016 to 2036. In the low/medium/high screening scenarios, the proportion of patients screened for HCV was projected to increase to 60%/85%/99%, respectively, by 2036. We analyzed four treatment strategies: 1) no treatment, 2) all-oral direct-acting antivirals (DAAs) given to F3–F4 (CC) patients only, 3) all-oral DAAs to F2–F3–F4 (CC) patients, and 4) all-oral DAAs to all fibrosis patients.
Results: Low, medium, and high HCV screening scenarios projected that 3,838, 5,665, and 7,669 individuals will be diagnosed with HCV infection, respectively, from 2016 to 2036, or 40% of those aged 18–39 years, and 60% of those aged 40–80 years. With no treatment, the projected number of patients reaching CC, DCC, HCC, or LrD in 2036 was 899, 147, 131, and 147, respectively, for the 18–39 years age group. For the 40–80 years age group, these projections were substantially greater: 2,828 CC, 736 DCC, 668 HCC, and 958 LrD. The overall economic burden without treatment reached 150 million EUR. However, introducing DAAs for F0–F4 patients was projected to increase the proportion of remaining life-years spent in sustained virologic response 12 weeks after treatment by 43% and 62% compared to DAAs given at F2–F4 or F3–F4 only, respectively.
Conclusion: An enhanced screening policy combined with broader access to DAAs can diminish the future clinical and economic burden of HCV in the Lebanese population and, for the middle-aged and elderly, provide the greatest health benefit with net cost savings.
Keywords: hepatitis C, epidemiology, burden of disease, screening, Lebanon, HCV treatment, screening and treatment policies
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