Impact of pegylated interferon and ribavirin on morbidity and mortality in patients with chronic hepatitis C and normal aminotransferases in France

Abstract

Clinicians continue to raise questions concerning the necessity of treating chronic hepatitis C virus (HCV)‐infected patients with normal alanine aminotransferase (N‐ALT), in light of their slower progression to cirrhosis than patients with elevated alanine aminotraferase (E‐ALT). This study was undertaken to predict the impact of pegylated interferon (IFN) and ribavirin on HCV‐related morbidity and mortality in patients with N‐ALT. A previous Markov model was adapted to separately simulate patients with N‐ALT (30%) and those with E‐ALT (70%). The model estimates fibrosis progression rates according to age, sex, and whether ALT levels are normal or elevated, assuming that patients with E‐ALT have a 2.6 times higher progression than those with N‐ALT. It takes into account improvement in HCV screening and treatment and competitive mortality. We assumed that N‐ALT patients were treated 80% less frequently between 2002 and 2004 and 70% less frequently from 2005 on, as obtained in real life from three multicentric cohorts (Hepatys, Adequation, Persee). Antiviral treatment of HCV‐infected populations might reduce 2008‐2025 HCV‐related morbidity and mortality by 34,200 cases of cirrhosis (36%, 33,000‐35,000), 22,400 complications (28%, 21,000‐23,000) and 17,500 deaths (25%, 17,000‐18,000), including 3000 cases of cirrhosis (22%, 2000‐5000), 1200 complications (15%, 1000‐1700), and 1000 deaths (14%, 900‐1300) in the N‐ALT population, despite a probability of receiving treatment that is three to five times less in this population. If N‐ALT patients are treated at the same proportions as those with E‐ALT, morbidity and mortality could be further reduced by 1400 cases of cirrhosis (13%, 1200‐2200), 600 complications (9%, 600‐1000), and 500 deaths (9%, 500‐800). Conclusion: Treatment of N‐ALT patients would decrease HCV morbidity and mortality. These patients should be considered candidates for treatment just as others are. (HEPATOLOGY 2009.)