Enhanced antiviral treatment efficacy and uptake in preventing the rising burden of hepatitis C-related liver disease and costs in Australia

Background and Aim Chronic hepatitis C virus (HCV) infection is an important cause of advanced liver disease and liver‐related deaths in Australia. Our aim was to describe the burden of HCV infection and consider treatment strategies to reduce HCV‐related morbidity and mortality. Methods Baseline model parameters were based upon literature review and expert consensus with a focus on Australian data. Three treatment scenarios based on anticipated introduction of improved direct‐acting antiviral regimens were considered to reduce HCV disease burden. Scenario 1 evaluated the impact of increased treatment efficacy alone (to 80–90% by 2016). Scenario 2 evaluated increased efficacy and increased treatment uptake (2550 to 13 500 by 2018) without treatment restriction, while Scenario 3 considered the same increases with treatment limited to ≥ F3 during 2015–2017. Results In 2013, there were an estimated 233 490 people with chronic HCV infection: 13 850 with cirrhosis, 590 with hepatocellular carcinoma (HCC) and 530 liver‐related deaths. If the current HCV treatment setting is unchanged, threefold increases in the number of people with cirrhosis, HCC, and liver disease deaths will be seen by 2030. Scenario 1 resulted in modest impacts on disease burden (4% decrease in HCC, decompensated cirrhosis, and liver deaths) and costs. Scenario 3 had the greatest impact on disease burden (approximately 50% decrease in HCC, decompensated cirrhosis, and liver deaths) and costs, while Scenario 2 had slightly lesser impact. Conclusions Considerable increases in the burden of HCV‐related advanced liver disease and its complications will be seen in Australia under current treatment levels and outcomes. Introduction of improved direct‐acting antiviral regimens with enhanced efficacy at current treatment levels will lead to limited impacts on this disease burden. A combination of increased treatment efficacy and greater uptake is required to achieve major reductions in advanced liver disease and related costs.