Global Distribution of HCV Infection. HCV Disease Burden Modeling 2.

Global Distribution of HCV Infection

2

HCV Disease Burden Modeling

3

HCV Disease Progression

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.

Compensated Cirrhosis

Hepatocellular Carcinoma

Liver Transplantation

Acute Hepatitis

Chronic Hepatitis – F3

Liver Related Death




Decompensated Cirrhosis

Spontaneously Cured

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HCV Disease Progression Modeling

Refractory Ascites (NC)

Acute HCV Infection

F3 (NC)

Liver Related Mortality

F0 – New Cases (NC)

F1 (NC) F2 (NC)

F0 – Total Cases (TC)

F1 (TC) F2 (TC)

Comp Cirrhosis (NC)

Diuretic Sensitive Ascites (NC)

Variceal Hemorrhage (NC)

Hepatic Encephal. (NC)

Hepatocellular Carcinoma (NC)

Background Mortality +

Cured

Spontaneously Cured

Comp. Cirrhosis (TC)

Refractory Ascites (TC)

Liver Transplantation

Diuretic Sensitive Ascites (TC)

Variceal Hemorrhage (TC)

Hepatic Encephal. (TC)

Hepatocellular Carcinoma (TC)

F3 (TC)

5

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

Fu

ture

Str

ateg

ies

Historical Trends

Calculations

Calculates the progression of patients and associated

costs from Incidence (newly infected) to Cured or

Death.

Input

Contains input data for Population, Incidence,

Mortality Rates, Disease Progression Rates and several other measures.

Dashboard

User input sheet for assumptions about future

Incidence, Diagnosis, Treatment Eligibility, SVR

Rates and Costs.

Outputs

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 HCVInfections

Cured Mortality

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.

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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


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Age distribution, 2013Germany, England, France and Spain

0%

2%

4%

6%

8%

10%

12%

14%

16%

18%

% o

f T

ota

l H

CV

Infe

cti

on

s (

20

13

)

Germany England France Spain


11

Age distribution, 2013 Brazil, Egypt, Australia and Turkey

0%

2%

4%

6%

8%

10%

12%

14%

16%

18%

% o

f T

ota

l H

CV

Infe

cti

on

s (

20

13

)

Brazil Egypt Australia Turkey


12

HCC, decompensated cirrhosis and transplant, 1950-2030 Germany, England, France and Spain


13

HCC, decompensated cirrhosis and transplant, 1950-2030 Brazil, Egypt, Australia and Turkey


14

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


16

Cirrhosis, 2013-2030 Germany, England, France and Spain


17

Cirrhosis, 2013-2030 Brazil, Egypt, Australia and Turkey


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HCC, 2013-2030 Germany, England, France and Spain


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HCC, 2013-2030Brazil, Egypt, Australia and Turkey


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Liver-related deaths, 2013-2030Germany, England, France and Spain


21

Liver-related deaths, 2013-2030Brazil, Egypt, Australia and Turkey


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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

25

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)

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Anti-HCV Prevalence (Reported)


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Anti-HCV Prevalence (Reported + Extrapolated)


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Viremic HCV Prevalence(Reported)


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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%

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Total Viremic HCV Infections (Reported + Extrapolated)


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HCV Viremic Infections(Prevalence & Total Infected)

Total Infected (Viremic)

200K-650K

650K-1.9M

0-200K

1.9M-3.5M

3.5M-9.2M

Prevalence(Viremic)

0.0%-0.6%

0.6%-0.8%

0.8%-1.3%

1.3%-2.9%

2.9%-7.8%


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Total Viremic HCV InfectionsCountries Responsible for 80% of Global Infections


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HCV Genotype Distribution

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Genotype Distribution, by Global Burden of Disease (GBD) Region


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HCV Genotype Distribution Globally

Genotype 1 48%

Genotype 2 14%

Genotype 3 22%

Genotype 4 13%

Genotype 5 1%

Genotype 6 2%

1a7%

1b23%

1 (Other)

18%2a2%

2b1%

2 (Other)

11%

3a11%

3b1%

3 (Other)

10%

413%

51%

62%


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Genotype Distribution by World Bank Regions

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.

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

High income Upper middle income Lower middle income Low income

1a 1b 1 (Other) 2 3 4 5 6

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Genotype Distribution by Region

Razavi H, Gower E, Estes C, Hindman S. Global HCV Genotypes. AASLD 2013; 2013 Nov 1-5; Washington, DC, United States.

Prevalence (Viremic)

0.0%-0.6%

0.6%-0.8%

0.8%-1.3%

1.3%-2.9%

2.9%-7.8%

North America Europe, Western Europe, Central Europe, Eastern Asia, Central Asia Pacific, High Income Asia, South

Asia, Southeast

Asia, East

Australasia

Sub-Saharan Africa, WestSub-S Africa, SouthernSub-S Africa, CentralNorth Africa/Middle EastLatin America, AndeanLatin America, Southern

Latin America, Tropical

Latin America, Central

Caribbean

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Genotype Distribution by Region

Razavi H, Gower E, Estes C, Hindman S. Global HCV Genotypes. AASLD 2013; 2013 Nov 1-5; Washington, DC, United States.

Prevalence(Viremic)

0.0%-0.6%

0.6%-0.8%

0.8%-1.3%

1.3%-2.9%

2.9%-7.8%


200K-650K

650K-1.9M

0-200K

1.9M-3.5M

3.5M-9.2M

North America Europe, Western Europe, Central Europe, Eastern Asia, Central Asia Pacific, High Income Asia, South

Asia, Southeast

Asia, East

Australasia

Sub-Saharan Africa, WestSub-S Africa, SouthernSub-S Africa, CentralNorth Africa/Middle EastLatin America, AndeanLatin America, Southern

Latin America, Tropical

Latin America, Central

Caribbean

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Albania

Armenia

AustriaBelarus

Belgium

Bosnia & HerzegovinaCroatia

Czech RepublicDenmark

Estonia

Finland

France

Georgia

Germany

Greece

Ireland

Italy

LatviaLithuania

Luxembourg

MacedoniaMontenegro

Hungary

Netherlands

PolandNorway

Portugal

Romania

Russia

Slovakia

Slovenia

Sweden

Switzerland

Turkey

United Kingdom

Serbia

Spain

HCV Prevalence and Genotype DistributionEurope

Gower, E., Estes C., Hindman, S., Razavi-Shearer, K., Razavi, H., Journal of Hepatology (2014)

Prevalence(Viremic)

0.0%-0.6%

0.6%-0.8%

0.8%-1.3%

1.3%-2.9%

2.9%-7.8%


200K-650K

650K-1.9M

0-200K

1.9M-3.5M

40

Algeria

Central African

Republic

Burkina Faso

Congo

Egypt

Equatorial Guinea

Ethiopia

Gabon

Gambia

Ghana

Guinea Bissau Iran

South Africa

SyriaTunisia

UAE

IraqIsrael Jordan KuwaitLebanonLibya

MadagascarMozambique

Morocco

Nigeria

Palestine

Saudi Arabia

HCV Prevalence and Genotype DistributionAfrica & Middle East



200K-650K

650K-1.9M

0-200K

1.9M-3.5M

3.5M-9.2M

Prevalence(Viremic)

0.0%-0.6%

0.6%-0.8%

0.8%-1.3%

1.3%-2.9%

2.9%-7.8%

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Cambodia

China

Hong Kong

India

Indonesia

Japan

Korea

LaosMalaysia

Mongolia

AustraliaMyanmarNew

Zealand

Pakistan

Philippines

Taiwan

Tajikistan

Uzbekistan

ThailandVietnam

Sri Lanka

HCV Prevalence and Genotype DistributionCentral Asia, South East Asia & Australia Pacific



200K-650K

650K-1.9M

0-200K

1.9M-3.5M

3.5M-9.2M

Prevalence(Viremic)

0.0%-0.6%

0.6%-0.8%

0.8%-1.3%

1.3%-2.9%

2.9%-7.8%

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Argentina

Brazil

Chile

Colombia

CubaDominican Republic

Mexico

Peru

Puerto Rico

Venezuela

HCV Prevalence and Genotype DistributionLatin America



200K-650K

650K-1.9M

0-200K

Prevalence(Viremic)

0.0%-0.6%

0.6%-0.8%

0.8%-1.3%

1.3%-2.9%

2.9%-7.8%

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HCV Treatment Rate

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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.

Global Distribution of HCV Infection. HCV Disease Burden Modeling 2.

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