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Impact of the COVID 19 Pandemic on HCV Elimination in Spain
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Published:December 19, 2020 Maria Buti et al.
• The implementation of actions like telehealth, home-delivery services for drugs or HCV screening when COVID tests are performed, some of them already in place in some centers, could minimize the impact of COVID pandemic on HCV patients and HCV elimination.
• An 18-month delay in HCV diagnosis and treatment due to the COVID pandemic in a cohort of 15,859 patients would increase the number of liver-related deaths, HCC, and HCV-related decompensated cirrhosis by 117, 73, and 118 cases, respectively. In economic terms this would translate to a 1.0. M cost increase due to decompensated cirrhosis and 1.3 M increase due to HCC. Furthermore, a high number of patients 14 (34 vs. 48) would need a liver transplant due to decompensated cirrhosis or HCC. The cost associated with liver transplantation would increase by 2.5 M (5.8 vs 8.3) for the total cohort during this period.
• See full text below
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Impact of COVID-19 on global HCV elimination efforts - (11/09/20)
Results: The'1-year delay' scenario resulted in 44,800 (95%uncertainty interval [UI]: 43,800-49,300) excess hepatocellularcarcinoma cases and 72,300 (95% UI: 70,600-79,400) excess liver-related deaths, relative to the 'no-delay' scenario globally, from 2020 to 2030. Most missed treatments would be in lower-middle income countries, whereas most excess hepatocellularcarcinoma and liver-related deaths would be among high-income countries.
Without real routine screening of 80% or more HCV elimination will not be reached in USA & deaths will increase & current screening in the USA is far from this:
AASLD: Determining Feasibility of Hepatitis C Elimination in the United States Using a Simulation Model - (11/16/20)
HOWVER, there are several models to screen, link and treat HCV that were presented at AASLD:
AASLD: AUTOMATED VIRAL HEPATITIS (HCV AND HBV) SCREENING: LESSONS ON EXPANSION & SUSTAINABILITY AMIDST THE COVID-19 PANDEMIC - (12/18/20) in NJ
AASLD: Provision of Hepatitis C Care in a Federally Qualified Health Center during the COVID-19 Pandemic - (11/13/20) in Philadelphia
AASLD: ELIMINATING HEPATITIS C: A COMPREHENSIVE PROGRAM OF DIGITAL CASE FINDING AND LINKAGE TO CARE ACROSS A LARGE URBAN HEALTHCARE SYSTEM - (11/13/20) in NYC
AASLD: POINT-OF-CARE HEPATITIS C TESTING AND TREATING STRATEGY IN PEOPLE WHO INJECT DRUGS IN HARM REDUCTION AND ADDICTION CENTERS FOR HEPATITIS C ELIMINATION(11/19/20)
AND THIS SIMPLIFIED treatment approach: AASLD: The "Keep It Simple and Safe" Approach to HCV Treatment: Primary Outcomes from the ACTG A5360 (MINMON) Study (11/19/20)
AND here are 2 of many studies reporting successful treating of PWUDs:
AASLD: Real-World Outcomes in Patients With Chronic Hepatitis C Virus Infection and Substance Use Disorders Treated With Glecaprevir/Pibrentasvir for 8 Weeks: A Pooled Analysis of Multinational Postmarketing Observational Studies(11/19/20)
AASLD: A Multisite Randomized Pragmatic Trial of Patient-Centered Models of Hepatitis C Treatment for People Who Inject Drugs: The HERO Study - Hepatitis C Real Options - (11/16/20)
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Impact of the COVID 19 Pandemic on HCV Elimination in Spain
Published: December 19, 2020 Journal of Hepatology - Received Date: 14 December 2020 - Maria Buti, Raquel DomÃnguez-Hernández, Miguel Angel Casado
• delaying HCV elimination programs will be associated with an increase in HCV-related morbidity and mortality in the next 10 years.
• Spain was on track for HCV elimination, but the COVID-19 pandemic has hindered efforts to maintain the cascade of care for HCV and many microelimination programs 7
• The implementation of actions like telehealth, home-delivery services for drugs or HCV screening when COVID tests are performed, some of them already in place in some centers, could minimize the impact of COVID pandemic on HCV patients and HCV elimination.
• In summary, hepatitis C elimination must continue to be a political goal and a priority of our health system to achieve the WHO goals by 2030.
• An 18-month delay in HCV diagnosis and treatment due to the COVID pandemic in a cohort of 15,859 patients would increase the number of liver-related deaths, HCC, and HCV-related decompensated cirrhosis by 117, 73, and 118 cases, respectively.
To the Editor,
We read with great interest the article by Sarah Blach and coworkers1 investigating the impact of COVID-19 on the global hepatitis C elimination efforts. The authors show that over the next 10 years a 1-year delay scenario related to COVID-19 would result in 44,800 excess hepatocellular carcinoma (HCC) cases globally and 72,300 excess liver-related deaths, relative to a no delay scenario. The excess HCC cases and deaths would be among high-income countries 1. Spain is one of the 45 high-income countries on the right track to reach HCV elimination by 2030 if the current screening and therapy rates are maintained2. However, COVID-19 strongly hit the country in March 2020 and continues to date. The first wave from March to June prompted a country-wide lockdown and the second wave has been ongoing since September. During this overall period, there has been a drop in HCV testing, linkage to care, harm reduction programs, and microelimination programs3. We aimed to assess the impact of COVID-19 on hepatitis C elimination in Spain.
A previously validated Markov model4 was adapted to simulate the effect of pandemic-related delays in HCV diagnosis and treatment on future advanced liver-related disease and deaths in the next 10 years. We used the data obtained to evaluate repercussions on the WHO goals by 2030 and to calculate the economic impact regarding healthcare costs (, 2020).
A cohort of 15,859 patients was analysed comparing two scenarios: the non-COVID-19 scenario, where all patients would be diagnosed and treated in the first year, 2020, and the COVID-19 scenario where there would be an 18-month delay from the beginning of 2020 to the end of June 2021 with a view to the expected vaccine availability in mid-2021. The simulation used clinical data from HCV patients treated with direct-acting antivirals in Spain (January 2019 to August 2020)5. In the COVID-19 scenario, the number of monthly HCV treatments was decreased between 19% and 84%5 from early 2020 to June 2021. In addition, it was assumed that patients would be treated in the following year and a half (50% since July 2021 and 50% during 2022), based on the 2019 distribution of patients. Patients with a delay in diagnosis and treatment progressed according to the natural course of the disease. Cohort baseline characteristics (average age and fibrosis) and sustained virological response were taken from published real-world data in Spain5
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The figure 1 shows the results for both scenarios by 2030. An 18-month delay in HCV diagnosis and treatment due to the COVID pandemic in a cohort of 15,859 patients would increase the number of liver-related deaths, HCC, and HCV-related decompensated cirrhosis by 117, 73, and 118 cases, respectively. In economic terms this would translate to a 1.0. M cost increase due to decompensated cirrhosis and 1.3 M increase due to HCC. Furthermore, a high number of patients 14 (34 vs. 48) would need a liver transplant due to decompensated cirrhosis or HCC. The cost associated with liver transplantation would increase by 2.5 M (5.8 vs 8.3) for the total cohort during this period.
Fig. 1Impact on HCV burden (clinical and economic) in the next 10 years because of the COVID-19-related diagnostic and treatment delay
The data derived here are based on a simulation with 15,859 patients, but it is estimated that 76,839 people still have active HCV infection in Spain6. Thus, if a larger number of HCV patients is affected by COVID19 pandemic, the actual clinical and economic impact would be greater. The data we report were estimated with a different methodology than that used by Blach1 in her study on the global impact of COVID 19 on hepatitis C elimination. Nonetheless, the findings are similar: delaying HCV elimination programs will be associated with an increase in HCV-related morbidity and mortality in the next 10 years.
Spain was on track for HCV elimination, but the COVID-19 pandemic has hindered efforts to maintain the cascade of care for HCV and many microelimination programs7. The excess morbidity and mortality due to this delay will require reinforcement of screening programs, particularly in vulnerable populations and those with more difficult access to primary care physicians8. This will be possible mainly by applying the EASL guideless for hepatitis C9. In summary, hepatitis C elimination must continue to be a political goal and a priority of our health system to achieve the WHO goals by 2030. The implementation of actions like telehealth, home-delivery services for drugs or HCV screening when COVID tests are performed, some of them already in place in some centers, could minimize the impact of COVID pandemic on HCV patients and HCV elimination.
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