Global Distribution of HCV Infection
HCV Disease Burden Modeling
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HCV Disease Progression
Acute Hepatitis
Spontaneously
Cured
Chronic
Hepatitis – F0
Chronic
Hepatitis – F1
Chronic
Hepatitis – F2
Chronic
Hepatitis – F3
Hepatocellular
Carcinoma
Decompensated
Cirrhosis
Liver Related
Death
Liver
Transplantation
Compensated
Cirrhosis
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.
3
HCV Disease Progression Modeling
Acute HCV
Infection
Spontaneously
Cured
F0 – New Cases
(NC)
F1 (NC)
F2 (NC)
F3 (NC)
Comp Cirrhosis
(NC)
F0 – Total Cases
(TC)
F1 (TC)
F2 (TC)
F3 (TC)
Comp. Cirrhosis
(TC)
Diuretic Sensitive
Ascites (NC)
Variceal
Hemorrhage (NC)
Hepatic Encephal.
(NC)
Hepatocellular
Carcinoma (NC)
Diuretic Sensitive
Ascites (TC)
Variceal
Hemorrhage (TC)
Hepatic Encephal.
(TC)
Hepatocellular
Carcinoma (TC)
Refractory Ascites
(NC)
Liver
Transplantation
Background
Mortality +
Cured
Liver Related
Mortality
Refractory Ascites
(TC)
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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
Historical Trends
Input
Future Strategies
Contains input data for
Population, Incidence,
Mortality Rates, Disease
Progression Rates and
several other measures.
Dashboard
Calculations
Outputs
User input sheet for
assumptions about future
Incidence, Diagnosis,
Treatment Eligibility, SVR
Rates and Costs.
Calculates the progression
of patients and associated
costs from Incidence
(newly infected) to Cured or
Death.
Displays a summary table of
the key output measures
and more detailed results in
numerous charts.
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The epidemiology of hepatitis C can be explained using a leaky
bucket as an analogy
New HCV
Infections
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.
Cured
Mortality
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HCV Disease Burden – A Comparison
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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.
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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.
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Age distribution, 2013
Germany, England, France and Spain
% of Total HCV Infections (2013)
18%
16%
14%
12%
10%
8%
6%
4%
2%
0%
Germany
England
France
Razavi H, Waked I, Sarrazin C, Myers RP, Idilman R, Calinas F, et al. J Viral Hepat 2014;21 Suppl 1:34-59.
Spain
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Age distribution, 2013
Brazil, Egypt, Australia and Turkey
% of Total HCV Infections (2013)
18%
16%
14%
12%
10%
8%
6%
4%
2%
0%
Brazil
Egypt
Australia
Razavi H, Waked I, Sarrazin C, Myers RP, Idilman R, Calinas F, et al. J Viral Hepat 2014;21 Suppl 1:34-59.
Turkey
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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.
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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.
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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.
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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.
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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.
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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.
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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.
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HCC, 2013-2030
Brazil, Egypt, Australia and Turkey
Wedemeyer H, Duberg AS, Buti M, et al. J Viral Hepat 2014; 21 Suppl 1: 60-89.
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Liver-related deaths, 2013-2030
Germany, England, France and Spain
Wedemeyer H, Duberg AS, Buti M, et al. J Viral Hepat 2014; 21 Suppl 1: 60-89.
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Liver-related deaths, 2013-2030
Brazil, Egypt, Australia and Turkey
Wedemeyer H, Duberg AS, Buti M, et al. J Viral Hepat 2014; 21 Suppl 1: 60-89.
21
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.
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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.
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HCV Prevalence
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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)
25
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)
26
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)
27
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)
28
Viremic HCV Prevalence
(Reported + Extrapolated)
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)
29
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)
30
HCV Viremic Infections
(Prevalence & Total Infected)
Prevalence
(Viremic)
Total Infected
(Viremic)
0.0%-0.6%
0-200K
0.6%-0.8%
200K-650K
0.8%-1.3%
650K-1.9M
1.3%-2.9%
1.9M-3.5M
2.9%-7.8%
3.5M-9.2M
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
Total Viremic HCV Infections
Countries 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)
32
HCV Genotype Distribution
33
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)
34
HCV Genotype Distribution
Globally
4
13%
5
1%
6
2%
1a
7%
1b
23%
3
(Other)
10%
3b
1%
1
(Other)
18%
3a
11%
2
(Other)
11%
2b
1%
Genotype 1
48%
Genotype 2
14%
Genotype 3
22%
Genotype 4
13%
Genotype 5
1%
Genotype 6
2%
2a
2%
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
Genotype Distribution by World Bank Regions
100%
90%
80%
70%
60%
50%
40%
30%
20%
10%
0%
High income
1a
Upper middle income
1b
1 (Other)
Lower middle income
2
3
4
Low income
5
6
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.
36
Genotype Distribution by Region
North America
Europe, Western
Europe, Central
Europe, Eastern
Asia, Central
Asia Pacific, High Income
Caribbean
Asia, Southeast
Asia, East
Latin America, Central
Latin America, Tropical
Asia, South
Prevalence (Viremic)
Australasia
0.0%-0.6%
0.6%-0.8%
0.8%-1.3%
1.3%-2.9%
2.9%-7.8%
Latin America, Southern
Latin America, Andean
North Africa/Middle East
Sub-S Africa, Central
Sub-S Africa, Southern
Razavi H, Gower E, Estes C, Hindman S. Global HCV Genotypes. AASLD 2013; 2013 Nov 1-5; Washington, DC, United States.
Sub-Saharan Africa, West
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Genotype Distribution by Region
North America
Europe, Western
Europe, Central
Europe, Eastern
Asia Pacific, High Income
Asia, Central
Caribbean
Asia, Southeast
Asia, East
Latin America, Central
Latin America, Tropical
Latin America, Southern
Asia, South
Prevalence
(Viremic)
Total Infected
(Viremic)
0.0%-0.6%
0-200K
0.6%-0.8%
200K-650K
0.8%-1.3%
650K-1.9M
1.3%-2.9%
1.9M-3.5M
2.9%-7.8%
3.5M-9.2M
Latin America, Andean
North Africa/Middle East
Sub-S Africa, Central
Sub-S Africa, Southern
Razavi H, Gower E, Estes C, Hindman S. Global HCV Genotypes. AASLD 2013; 2013 Nov 1-5; Washington, DC, United States.
Australasia
Sub-Saharan Africa, West
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HCV Prevalence and Genotype Distribution
Europe
Ireland
United
Kingdom
France
Switzerland
Belgium
Norway
Denmark
Sweden
Germany
Austria
Netherland
s
Finland
Hungary
Czech
Republic
Slovakia
Poland
Lithuania
Latvia
Belarus
Russia
Serbia
Romania
Georgia
Estonia
Turkey
Armenia
Albania
Macedonia
Luxembourg
Prevalence
(Viremic)
0.0%-0.6%
0.6%-0.8%
0.8%-1.3%
Total Infected
(Viremic)
0-200K
200K-650K
650K-1.9M
1.3%-2.9%
2.9%-7.8%
1.9M-3.5M
Portugal
Spain
Italy
Greece
Slovenia
Gower, E., Estes C., Hindman, S., Razavi-Shearer, K., Razavi, H., Journal of Hepatology (2014)
Croatia
Bosnia &
Herzegovina
Montenegro
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HCV Prevalence and Genotype Distribution
Africa & Middle East
Morocco
Algeria
Guinea
Bissau
Gambia
Burkina
Faso
Congo
Tunisia
Libya
Egypt
Palestine
Israel
Lebanon
Syria
Jordan
Kuwait
Iraq
UAE
Saudi
Arabia
Iran
Ghana
Nigeria
Central
African
Republic
Equatorial
Guinea
Mozambique
Gabon
South
Africa
Ethiopia
Madagascar
Prevalence
(Viremic)
0.0%-0.6%
0.6%-0.8%
0.8%-1.3%
Total Infected
(Viremic)
0-200K
200K-650K
650K-1.9M
1.9M-3.5M
1.3%-2.9%
2.9%-7.8%
Gower, E., Estes C., Hindman, S., Razavi-Shearer, K., Razavi, H., Journal of Hepatology (2014)
3.5M-9.2M
40
HCV Prevalence and Genotype Distribution
Central Asia, South East Asia & Australia Pacific
Tajikistan
Mongolia
Uzbekistan
Japan
Prevalence
(Viremic)
0.0%-0.6%
0.6%-0.8%
Pakistan
Hong
Kong
0.8%-1.3%
1.3%-2.9%
2.9%-7.8%
Total Infected
(Viremic)
India
Korea
0-200K
200K-650K
650K-1.9M
1.9M-3.5M
3.5M-9.2M
China
Sri Lanka
Vietnam
Myanmar
Thailand
Cambodia
Indonesia
Malaysia
Gower, E., Estes C., Hindman, S., Razavi-Shearer, K., Razavi, H., Journal of Hepatology (2014)
Laos
Philippine
s
Australia
New
Zealand
Taiwan
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HCV Prevalence and Genotype Distribution
Latin America
Dominican
Republic
Cuba
Mexico
Puerto Rico
Venezuela
Colombia
Brazil
Peru
Prevalence
(Viremic)
0.0%-0.6%
Total Infected
(Viremic)
0-200K
0.6%-0.8%
0.8%-1.3%
200K-650K
Chile
Argentina
1.3%-2.9%
650K-1.9M
2.9%-7.8%
Gower, E., Estes C., Hindman, S., Razavi-Shearer, K., Razavi, H., Journal of Hepatology (2014)
42
HCV Treatment Rate
43
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.
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