Theme: Epidemiology & Public Health Research Year: 2024
Background: Hepatitis C virus (HCV) represents the largest public health burden of any infectious disease. Fortunately, HCV is curable with direct-acting antivirals (DAAs). However, access to treatment was initially restricted around the world to individuals meeting specific thresholds of liver fibrosis and later expanded. Here, we provide updated estimates of trends in DAA utilization and HCV-related hospitalizations in Ontario, Canada.
Methods: We conducted a population-based analysis of the quarterly number of people dispensed a DAA, and the rate of HCV-related hospitalizations between April 1, 2015, and December 31, 2022. We used administrative healthcare data housed at ICES to identify all people eligible for public drug benefits who received a DAA and all HCV-related hospitalizations for liver-related conditions. All analyses were stratified by birth cohort (i.e., people born before and on/after January 1, 1976).
Results: Following coverage by the publicly funded drug benefit program, the number of people dispensed a DAA increased almost two-fold from Q2 2015 (N=422) to Q4 2022 (N=938). In Q4 2022, 3.0% of people dispensed a DAA had a prior HIV diagnosis. Trends in DAA dispensing differed by birth cohort, with 10.2% (N=403 to 444) and 2500.0% (N=19 to 494) increases among people born pre-1976 and during/after 1976, respectively. Over the same period, HCV-related hospitalizations decreased 56.7% (0.55 to 0.22 per 10,000). This differed by birth cohort, with a 63.9% decrease among people born pre-1976 (0.91 to 0.37 per 10,000), compared to a 13.1% decrease among people born during/after 1976 (0.16 to 0.11 per 10,000).
Conclusion: Across Ontario, HCV-related hospitalizations have declined in parallel with expanded access to DAAs among people with HCV. Differences observed among birth cohorts highlights the impact of these treatments in reducing healthcare system burden among people born pre-1976 and reinforces the need to make this group a priority for HCV screening.
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