Impact of viral eradication on mortality related to hepatitis C: A modeling approach in France

Background/Aims: In France, two recent studies enabled modeling of the impact of viral eradication on HCV mortality. Methods: The French HCV population was simulated from infection to death using a computer-based model. We took into account the impact of alcohol, present screening and antiviral therapy to predict 2006-2025 HCV mortality and to assess the impact of viral eradication. Results: In 2006, the model estimated that among HCV-RNA+, 55% were F0-F1, 18% F2, 22% F3-F4 and 6% had liver complications. The mortality ratio was 11-fold higher in alcoholic patients 40-65 years old. Current therapy will save 14,400 (95% CI, 13,900-15,000) lives compared to absence of therapy. Sensitivity analyses did not change the main results. Contrary to guidelines, if patients F < 2 were treated in the same proportions as those with F >= 2, 700 (95% CI, 700-750) lives would be saved. If screening were to reach 75% in 2010, 4 years earlier than model expectation, 950 (95%, CI, 900-1000) lives would be saved. If a new molecule improving eradication for genotype 1/4 by 40% were to become available in 2010, 1500 (95% CI, 1400-1600) lives would be saved. Conclusions: Current therapy is reducing HCV mortality. Therapeutic guidelines must take into account their impact on HCV mortality. (C) 2008 European Association for the Study of the Liver. Published by Elsevier B.V. All rights reserved.