Published online May 27, 2019. doi: 10.4254/wjh.v11.i5.421
Peer-review started: December 29, 2018
First decision: March 5, 2019
Revised: April 5, 2019
Accepted: April 19, 2019
Article in press: April 19, 2019
Published online: May 27, 2019
Processing time: 151 Days and 0.9 Hours
About 10 million people in China are infected with hepatitis C virus (HCV), with the seroprevalence of anti-HCV in the general population estimated at 0.6%. Delaying effective treatment of chronic hepatitis C (CHC) is associated with liver disease progression, cirrhosis, hepatocellular carcinoma, and liver-related mortality. The extrahepatic manifestations of CHC further add to the disease burden of patients. Managing CHC-related advanced liver diseases and systemic manifestations are costly for both the healthcare system and society. Loss of work productivity due to reduced well-being and quality of life in CHC patients further compounds the economic burden of the disease. Traditionally, pegylated-interferon plus ribavirin (PR) was the standard of care. However, a substantial number of patients are ineligible for PR treatment, and only 40%–75% achieved sustained virologic response. Furthermore, PR is associated with impairment of patient-reported outcomes (PROs), high rates of adverse events, and poor adherence. With the advent of direct acting antivirals (DAAs), the treatment of CHC patients has been revolutionized. DAAs have broader eligible patient populations, higher efficacy, better PRO profiles, fewer adverse events, and better adherence rates, thereby making it possible to cure a large proportion of all CHC patients. This article aims to provide a comprehensive evaluation on the value of effective, curative hepatitis C treatment from the clinical, economic, societal, and patient experience perspectives, with a focus on recent data from China, supplemented with other Asian and international experiences where China data are not available.
Core tip: Chronic hepatitis C is a systemic disease that manifests both hepatically and extrahepatically, leading to impaired patient-reported outcomes (PROs) and huge economic burden on the healthcare system and society. Direct acting antivirals are effective hepatitis C therapies that improve PROs and have broad eligible patient populations, good efficacy, few adverse events, and high adherence rates. Sustained virologic response is associated with improved clinical outcomes and increased work productivity. Curative therapies for hepatitis C was of substantial societal and economic value because they reduce productivity loss and avoid the management costs associated with advanced liver disease and extrahepatic manifestations.