International Journal of Epidemiology 2003;32:717-724
© International Epidemiological Association 2003
Special Theme: Infectious Diseases |
Modelling hepatitis C virus incidence, prevalence and long-term sequelae in Australia, 2001
1 National Centre in HIV Epidemiology and Clinical Research, The University of New South Wales, Sydney, Australia.
2 Australian Injecting and Illicit Drug Users League, Canberra, Australia.
3 Communicable Disease Control Branch, Department of Health, Perth, Australia.
4 Macfarlane Burnet Centre for Medical Research, Melbourne, Australia.
5 National Drug and Alcohol Research Centre, The University of New South Wales, Sydney, Australia.
6 Sexual Health Branch, Department of Health and Human Services, Hobart, Australia.
7 Austin-Repatriation Medical Centre, Melbourne, Australia.
8 Australian Hepatitis Council, Canberra, Australia.
9 Princess Alexandra Hospital, Brisbane, Australia.
10 Communicable Diseases and Health Protection Branch, Commonwealth Department of Health and Ageing, Canberra, Australia.
11 Alcohol and Drug Service, St Vincent’s Hospital, Sydney, Australia.
Dr Matthew Law, National Centre in HIV Epidemiology and Clinical Research, The University of New South Wales, 376 Victoria Street, Darlinghurst, NSW 2010, Australia. E-mail: mlaw{at}nchecr.unsw.edu.au
Background To plan an appropriate public health response to the hepatitis C virus (HCV) epidemic requires that estimates of HCV incidence and prevalence, and projections of the long-term sequelae of infection, are as accurate as possible. In this paper, mathematical models are used to synthesize data on the epidemiology and natural history of HCV in Australia to estimate HCV incidence and prevalence in Australia to end 2001, and project future trends in the long-term sequelae of HCV infection.
Methods Mathematical models of the HCV epidemic in Australia were developed based on estimates of the pattern of injecting drug use. Estimates of HCV infections due to injecting drug use were then adjusted to allow for HCV infections resulting from other transmission routes. Projections of the long-term sequelae of HCV infection were obtained by combining modelled HCV incidence with estimates of the progression rates to these outcomes.
Results It was estimated that there were 210 000 (lower and upper limits of 157 000 and 252 000) people in Australia living with HCV antibodies at the end of 2001, with HCV incidence in 2001 estimated to be 16 000 (11 000–19 000). It was estimated that 6500 (5000–8000) people were living with HCV-related cirrhosis in 2001, that 175 (130–210) people developed HCV-associated liver failure, and that there were 50 (40–60) incident cases of HCV-related hepatocellular carcinoma (HCC). It was estimated that in 2001 22 500 quality adjusted life years were lost to chronic HCV infection, the majority (77%) in people with early (stage 0/1) liver disease.
Discussion Model-based estimates were broadly consistent with other sources of information on the HCV epidemic in Australia. These models suggest that the prevalence of HCV-related cirrhosis and the incidence of HCV-related liver failure and HCC will more than triple in Australia by 2020.
Keywords Australia, drug abuse, epidemiology, hepatitis C, models
Accepted 23 December 2002
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