DDW-Complications Are Emerging for Baby Boomers With HCV

From Medscape Medical News

Complications Are Emerging for Baby Boomers With HCV

Caroline Helwick

May 19, 2012 (San Diego, California) — An analysis of claims data from 2008 shows that the majority of people infected with hepatitis C virus (HCV) are 45 to 64 years of age (i.e., the "baby boomer" generation), and that a significant proportion of these people will progress to advanced liver disease (ALD).

These findings were reported here at Digestive Disease Week 2012.
Chronic HCV can lead to ADL, including cirrhosis, decompensated cirrhosis, and liver cancer/transplantation. For people 45 to 64 years of age with non-ALD HCV infection, 4.4% progressed; in addition, 11.5% of cirrhotics developed decompensated cirrhosis and 3.2% went on to develop liver cancer or require transplantation.

This indicates an urgency to diagnose and treat these people before costly and irreversible complications develop, the investigators note.

In the United States in 2008, the estimated prevalence of patients with anti-HCV antibody was 3.6 million, with 1.1 million people estimated to be diagnosed with chronic HCV infection and 1.6 million believed to be undiagnosed.

Without treatment, the number of ALD patients is expected to increase from 198,000 in 2008 to 304,000 in 2015. Another 299,000 people currently undiagnosed with HCV infection will develop ALD, Martin Zalesak, MD, PhD, from Trinity Partners in Waltham, Massachusetts, and colleagues report.

"This alarming finding places additional stress on an already overburdened healthcare system, which will need to prepare for an increase in patients suffering from advanced liver disease," said coinvestigator Ann Kwong, PhD, vice president and HCV franchise lead at Vertex Pharmaceuticals in Cambridge, Massachusetts, which funded the study.

Large Databases Analyzed
Dr. Zalesak and colleagues aimed to determine the annual rates at which HCV-infected populations progress to ALD by age cohort, and to project the ALD prevalence to 2015, assuming lack of treatment. They used the commercial PharMetrics database and the Medicare database to identify HCV patients with and without ALD, using International Classification of Diseases, Ninth Edition (ICD-9) codes. Future ALD prevalence was projected using progression and mortality trends from these databases.

The number of patients diagnosed with ALD was tallied over a 3-year interval. Of the 1.1 million patients diagnosed with HCV infection, 16.1% were 16 to 44 years of age, 38.8% were 45 to 54 years of age, 36.4% were 55 to 64 years of age, and 8.6% were 65 years or older.
The proportion of these individuals diagnosed with ALD increased with age — 9.1% in the 16 to 44 year cohort, 17.1% in the 45 to 54 year cohort, and 22.4% in the 55 to 64 year cohort. After age 65, all-cause mortality overtook the incidence of ALD, which was 19.3% in this group.

The study was funded by Vertex Pharmaceuticals. Dr. Kwong is an employee of Vertex. Dr. Zalesak has disclosed no relevant financial relationships.

Digestive Disease Week (DDW) 2012. Abstract Sa1084. Presented May 19, 2012.
http://www.medscape.com/viewarticle/764095