Background
Since March 2016, Australia has developed a program of unrestricted access to highly effective direct-acting antiviral (DAA) therapy for hepatitis C virus (HCV). Subsequently, DAA uptake has rapidly increased nationally, with around 26% (n~60,000) of people with chronic HCV treated. To inform future HCV strategies, including the World Health Organization (WHO) target of 65% reduction in liver-related mortality by 2030, a program of monitoring and evaluation is essential. The aim of this study is to develop an evaluation framework to assess the population-level impact of DAAs on HCV-related liver disease burden.
Methods
In NSW, HCV notifications are linked to several administrative databases, comprising HIV diagnosis; antiviral therapy; hospitalisation, including those for decompensated cirrhosis (DC) and hepatocellular carcinoma (HCC); and mortality. The study population includes a retrospective cohort of ~112,000 people with an HCV notification, 1993-2017.
Results
Trends in total and age-standardised DC and HCC diagnosis and liver-related deaths will be presented, 2000-2017. Median survival following a DC or HCC diagnosis will be evaluated. Given high DAA therapy uptake among people with cirrhosis in 2016-2017, an impact on incidence of advanced liver disease complications and survival among people with advanced liver disease is anticipated.
Conclusions
Data linkage studies comprise a major component of HCV liver disease burden monitoring in the DAA era. Pre-DAAs, these studies have contributed to characterisation of the population-level burden of DC, HCC, and liver-related mortality. Data linkage studies continue to monitor the specific impact of DAA scale-up and guide progress towards WHO HCV 2030 elimination targets.