Global Distribution of HCV Infection. HCV Disease Burden Modeling 2.
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Transcript of Global Distribution of HCV Infection. HCV Disease Burden Modeling 2.
Global Distribution of HCV Infection
2
HCV Disease Burden Modeling
3
HCV Disease Progression
Razavi H, Waked I, Sarrazin C, et al. The present and future disease burden of hepatitis C virus (HCV) infection with today's treatment paradigm. J Viral Hepat 2014; 21 Suppl 1: 34-59.
Compensated Cirrhosis
Hepatocellular Carcinoma
Liver Transplantation
Acute Hepatitis
Chronic Hepatitis – F3
Liver Related Death
Chronic Hepatitis – F0
Chronic Hepatitis – F1
Chronic Hepatitis – F2
Decompensated Cirrhosis
Spontaneously Cured
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HCV Disease Progression Modeling
Refractory Ascites (NC)
Acute HCV Infection
F3 (NC)
Liver Related Mortality
F0 – New Cases (NC)
F1 (NC) F2 (NC)
F0 – Total Cases (TC)
F1 (TC) F2 (TC)
Comp Cirrhosis (NC)
Diuretic Sensitive Ascites (NC)
Variceal Hemorrhage (NC)
Hepatic Encephal. (NC)
Hepatocellular Carcinoma (NC)
Background Mortality +
Cured
Spontaneously Cured
Comp. Cirrhosis (TC)
Refractory Ascites (TC)
Liver Transplantation
Diuretic Sensitive Ascites (TC)
Variceal Hemorrhage (TC)
Hepatic Encephal. (TC)
Hepatocellular Carcinoma (TC)
F3 (TC)
5
HCV Disease Burden Model Characteristics
• Easy to use platform – Excel based model
• Transparent – All formulas are unprotected and visible
• Ties to historical data – Published data is used to calibrate the model up to 2013
• Measures the impact of future decisions – Interface to input potential strategies
Fu
ture
Str
ateg
ies
Historical Trends
Calculations
Calculates the progression of patients and associated
costs from Incidence (newly infected) to Cured or
Death.
Input
Contains input data for Population, Incidence,
Mortality Rates, Disease Progression Rates and several other measures.
Dashboard
User input sheet for assumptions about future
Incidence, Diagnosis, Treatment Eligibility, SVR
Rates and Costs.
Outputs
Displays a summary table of the key output measures
and more detailed results in numerous charts.
6
The epidemiology of hepatitis C can be explained using a leaky bucket as an analogy
New HCVInfections
Cured Mortality
At any point in time, the total number of individuals infected with HCV can be explained by the number of new infections, cured, and mortality since the
beginning of time.
7
HCV Disease Burden – A Comparison
8
Viremic HCV prevalence, 1950-2030 Germany, England, France and Spain
Razavi H, Waked I, Sarrazin C, Myers RP, Idilman R, Calinas F, et al. J Viral Hepat 2014;21 Suppl 1:34-59.
9
Viremic HCV prevalence, 1950-2030 Brazil, Egypt, Australia and Turkey
Razavi H, Waked I, Sarrazin C, Myers RP, Idilman R, Calinas F, et al. J Viral Hepat 2014;21 Suppl 1:34-59.
10
Age distribution, 2013Germany, England, France and Spain
0%
2%
4%
6%
8%
10%
12%
14%
16%
18%
% o
f T
ota
l H
CV
Infe
cti
on
s (
20
13
)
Germany England France Spain
Razavi H, Waked I, Sarrazin C, Myers RP, Idilman R, Calinas F, et al. J Viral Hepat 2014;21 Suppl 1:34-59.
11
Age distribution, 2013 Brazil, Egypt, Australia and Turkey
0%
2%
4%
6%
8%
10%
12%
14%
16%
18%
% o
f T
ota
l H
CV
Infe
cti
on
s (
20
13
)
Brazil Egypt Australia Turkey
Razavi H, Waked I, Sarrazin C, Myers RP, Idilman R, Calinas F, et al. J Viral Hepat 2014;21 Suppl 1:34-59.
12
HCC, decompensated cirrhosis and transplant, 1950-2030 Germany, England, France and Spain
Razavi H, Waked I, Sarrazin C, Myers RP, Idilman R, Calinas F, et al. J Viral Hepat 2014;21 Suppl 1:34-59.
13
HCC, decompensated cirrhosis and transplant, 1950-2030 Brazil, Egypt, Australia and Turkey
Razavi H, Waked I, Sarrazin C, Myers RP, Idilman R, Calinas F, et al. J Viral Hepat 2014;21 Suppl 1:34-59.
14
Estimated viremic infections, 2013-2030 Germany, England, France and Spain
Wedemeyer H, Duberg AS, Buti M, et al. J Viral Hepat 2014; 21 Suppl 1: 60-89.
15
Estimated viremic infections, 2013-2030 Brazil, Egypt, Australia and Turkey
Wedemeyer H, Duberg AS, Buti M, et al. J Viral Hepat 2014; 21 Suppl 1: 60-89.
16
Cirrhosis, 2013-2030 Germany, England, France and Spain
Wedemeyer H, Duberg AS, Buti M, et al. J Viral Hepat 2014; 21 Suppl 1: 60-89.
17
Cirrhosis, 2013-2030 Brazil, Egypt, Australia and Turkey
Wedemeyer H, Duberg AS, Buti M, et al. J Viral Hepat 2014; 21 Suppl 1: 60-89.
18
HCC, 2013-2030 Germany, England, France and Spain
Wedemeyer H, Duberg AS, Buti M, et al. J Viral Hepat 2014; 21 Suppl 1: 60-89.
19
HCC, 2013-2030Brazil, Egypt, Australia and Turkey
Wedemeyer H, Duberg AS, Buti M, et al. J Viral Hepat 2014; 21 Suppl 1: 60-89.
20
Liver-related deaths, 2013-2030Germany, England, France and Spain
Wedemeyer H, Duberg AS, Buti M, et al. J Viral Hepat 2014; 21 Suppl 1: 60-89.
21
Liver-related deaths, 2013-2030Brazil, Egypt, Australia and Turkey
Wedemeyer H, Duberg AS, Buti M, et al. J Viral Hepat 2014; 21 Suppl 1: 60-89.
22
Historical distribution by age and gender Germany, England, France and Spain
Bruggmann P, Berg T, Ovrehus AL, et al. J Viral Hepat 2014; 21 Suppl 1: 5-33.
23
Historical distribution by age and gender Brazil, Egypt, Australia and Turkey
Bruggmann P, Berg T, Ovrehus AL, et al. J Viral Hepat 2014; 21 Suppl 1: 5-33.
24
HCV Prevalence
25
Anti-HCV prevalence(Data Quality)
Gower, E., Estes C., Hindman, S., Razavi-Shearer, K., Razavi, H., Global epidemiology and genotype distribution of the hepatitis C virus, Journal of Hepatology (2014)
26
Anti-HCV Prevalence (Reported)
Gower, E., Estes C., Hindman, S., Razavi-Shearer, K., Razavi, H., Global epidemiology and genotype distribution of the hepatitis C virus, Journal of Hepatology (2014)
27
Anti-HCV Prevalence (Reported + Extrapolated)
Gower, E., Estes C., Hindman, S., Razavi-Shearer, K., Razavi, H., Global epidemiology and genotype distribution of the hepatitis C virus, Journal of Hepatology (2014)
28
Viremic HCV Prevalence(Reported)
Gower, E., Estes C., Hindman, S., Razavi-Shearer, K., Razavi, H., Global epidemiology and genotype distribution of the hepatitis C virus, Journal of Hepatology (2014)
29
Viremic HCV Prevalence(Reported + Extrapolated)
Gower, E., Estes C., Hindman, S., Razavi-Shearer, K., Razavi, H., Global epidemiology and genotype distribution of the hepatitis C virus, Journal of Hepatology (2014)
Prevalence (Viremic)
0.0%-0.6%
0.6%-0.8%
0.8%-1.3%
1.3%-2.9%
2.9%-7.8%
30
Total Viremic HCV Infections (Reported + Extrapolated)
Gower, E., Estes C., Hindman, S., Razavi-Shearer, K., Razavi, H., Global epidemiology and genotype distribution of the hepatitis C virus, Journal of Hepatology (2014)
31
HCV Viremic Infections(Prevalence & Total Infected)
Total Infected (Viremic)
200K-650K
650K-1.9M
0-200K
1.9M-3.5M
3.5M-9.2M
Prevalence(Viremic)
0.0%-0.6%
0.6%-0.8%
0.8%-1.3%
1.3%-2.9%
2.9%-7.8%
Gower, E., Estes C., Hindman, S., Razavi-Shearer, K., Razavi, H., Global epidemiology and genotype distribution of the hepatitis C virus, Journal of Hepatology (2014)
32
Total Viremic HCV InfectionsCountries Responsible for 80% of Global Infections
Gower, E., Estes C., Hindman, S., Razavi-Shearer, K., Razavi, H., Global epidemiology and genotype distribution of the hepatitis C virus, Journal of Hepatology (2014)
33
HCV Genotype Distribution
34
Genotype Distribution, by Global Burden of Disease (GBD) Region
Gower, E., Estes C., Hindman, S., Razavi-Shearer, K., Razavi, H., Global epidemiology and genotype distribution of the hepatitis C virus, Journal of Hepatology (2014)
35
HCV Genotype Distribution Globally
Genotype 1 48%
Genotype 2 14%
Genotype 3 22%
Genotype 4 13%
Genotype 5 1%
Genotype 6 2%
1a7%
1b23%
1 (Other)
18%2a2%
2b1%
2 (Other)
11%
3a11%
3b1%
3 (Other)
10%
413%
51%
62%
Gower, E., Estes C., Hindman, S., Razavi-Shearer, K., Razavi, H., Global epidemiology and genotype distribution of the hepatitis C virus, Journal of Hepatology (2014)
36
Genotype Distribution by World Bank Regions
Razavi H, Gower E, Estes C, Hindman S. Global HCV Genotypes. Poster presented at: The Liver Meeting 2013; 2013 Nov 1-5; Washington, DC, United States.
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
High income Upper middle income Lower middle income Low income
1a 1b 1 (Other) 2 3 4 5 6
37
Genotype Distribution by Region
Razavi H, Gower E, Estes C, Hindman S. Global HCV Genotypes. AASLD 2013; 2013 Nov 1-5; Washington, DC, United States.
Prevalence (Viremic)
0.0%-0.6%
0.6%-0.8%
0.8%-1.3%
1.3%-2.9%
2.9%-7.8%
North America Europe, Western Europe, Central Europe, Eastern Asia, Central Asia Pacific, High Income Asia, South
Asia, Southeast
Asia, East
Australasia
Sub-Saharan Africa, WestSub-S Africa, SouthernSub-S Africa, CentralNorth Africa/Middle EastLatin America, AndeanLatin America, Southern
Latin America, Tropical
Latin America, Central
Caribbean
38
Genotype Distribution by Region
Razavi H, Gower E, Estes C, Hindman S. Global HCV Genotypes. AASLD 2013; 2013 Nov 1-5; Washington, DC, United States.
Prevalence(Viremic)
0.0%-0.6%
0.6%-0.8%
0.8%-1.3%
1.3%-2.9%
2.9%-7.8%
Total Infected (Viremic)
200K-650K
650K-1.9M
0-200K
1.9M-3.5M
3.5M-9.2M
North America Europe, Western Europe, Central Europe, Eastern Asia, Central Asia Pacific, High Income Asia, South
Asia, Southeast
Asia, East
Australasia
Sub-Saharan Africa, WestSub-S Africa, SouthernSub-S Africa, CentralNorth Africa/Middle EastLatin America, AndeanLatin America, Southern
Latin America, Tropical
Latin America, Central
Caribbean
39
Albania
Armenia
AustriaBelarus
Belgium
Bosnia & HerzegovinaCroatia
Czech RepublicDenmark
Estonia
Finland
France
Georgia
Germany
Greece
Ireland
Italy
LatviaLithuania
Luxembourg
MacedoniaMontenegro
Hungary
Netherlands
PolandNorway
Portugal
Romania
Russia
Slovakia
Slovenia
Sweden
Switzerland
Turkey
United Kingdom
Serbia
Spain
HCV Prevalence and Genotype DistributionEurope
Gower, E., Estes C., Hindman, S., Razavi-Shearer, K., Razavi, H., Journal of Hepatology (2014)
Prevalence(Viremic)
0.0%-0.6%
0.6%-0.8%
0.8%-1.3%
1.3%-2.9%
2.9%-7.8%
Total Infected (Viremic)
200K-650K
650K-1.9M
0-200K
1.9M-3.5M
40
Algeria
Central African
Republic
Burkina Faso
Congo
Egypt
Equatorial Guinea
Ethiopia
Gabon
Gambia
Ghana
Guinea Bissau Iran
South Africa
SyriaTunisia
UAE
IraqIsrael Jordan KuwaitLebanonLibya
MadagascarMozambique
Morocco
Nigeria
Palestine
Saudi Arabia
HCV Prevalence and Genotype DistributionAfrica & Middle East
Gower, E., Estes C., Hindman, S., Razavi-Shearer, K., Razavi, H., Journal of Hepatology (2014)
Total Infected (Viremic)
200K-650K
650K-1.9M
0-200K
1.9M-3.5M
3.5M-9.2M
Prevalence(Viremic)
0.0%-0.6%
0.6%-0.8%
0.8%-1.3%
1.3%-2.9%
2.9%-7.8%
41
Cambodia
China
Hong Kong
India
Indonesia
Japan
Korea
LaosMalaysia
Mongolia
AustraliaMyanmarNew
Zealand
Pakistan
Philippines
Taiwan
Tajikistan
Uzbekistan
ThailandVietnam
Sri Lanka
HCV Prevalence and Genotype DistributionCentral Asia, South East Asia & Australia Pacific
Gower, E., Estes C., Hindman, S., Razavi-Shearer, K., Razavi, H., Journal of Hepatology (2014)
Total Infected (Viremic)
200K-650K
650K-1.9M
0-200K
1.9M-3.5M
3.5M-9.2M
Prevalence(Viremic)
0.0%-0.6%
0.6%-0.8%
0.8%-1.3%
1.3%-2.9%
2.9%-7.8%
42
Argentina
Brazil
Chile
Colombia
CubaDominican Republic
Mexico
Peru
Puerto Rico
Venezuela
HCV Prevalence and Genotype DistributionLatin America
Gower, E., Estes C., Hindman, S., Razavi-Shearer, K., Razavi, H., Journal of Hepatology (2014)
Total Infected (Viremic)
200K-650K
650K-1.9M
0-200K
Prevalence(Viremic)
0.0%-0.6%
0.6%-0.8%
0.8%-1.3%
1.3%-2.9%
2.9%-7.8%
43
HCV Treatment Rate
44
Treatment Rate, by Country, 2013
Razavi H, Waked I, Sarrazin C, Myers RP, Idilman R, Calinas F, et al. The present and future disease burden of hepatitis C virus (HCV) infection with today's treatment paradigm. J Viral Hepat 2014;21 Suppl 1:34-59.
Hatzakis A, Chulanov V, Gadano AC, Bergin C, Ben-Ari Z, Mossong J, et al. The present and future disease burden of hepatitis C virus (HCV) infection with today's treatment paradigm – J Viral Hepat 2014. Submitted for publication 30 July 2014.