Hepatitis C: The juggernaut rolls on unchecked The country is different but the problems facing Canada are very similar to the problems facing New Zealand


Hepatitis C: The juggernaut rolls on unchecked A Key Point summary of the Editorial that appeared in The Canadian Journal of Gastroenterology, Morris Sherman PhD FRCPC MB

Can J Gastroenterology Vol 22 No 4 April 2008

"a steady increase in hospital costs associated with the management of chronic hepatitis C. This is a result of an increase in the number of hospitalizations for hepatitis C, increases in in-hospital mortality and increased lengths of stay."

"incidence of complications and the mortality rate related to hepatitis C may be rising more quickly than predicted."

"Zou et al (2) predicted a doubling of these outcomes over the period from 1998 to 2008. In this issue, Myers et al find that the rates have increased fourfold over the decade of their study."

"Hepatitis C is a disease that is both preventable and treatable. Thus, the increase in mortality rates and the increase in costs are theoretically preventable."

"this is a potentially curable disease that currently afflicts approximately 250,000 Canadians (4) and continues to suck up resources that could be diverted elsewhere."

"The prevalence of chronic hepatitis C in Canada is increasing. "

"The rate at which new immigrants from endemic areas of the world bring hepatitis C into Canada (approximately 2000 annually) and the rate at which injection drug users are newly infected (estimated 6600 annually) exceeds the rate at which currently infected individuals are cured (more than 1000 annually) or die (estimated 4700 annually from all causes). "

"Thus, estimates of the number of patients with hepatitis C increased from approximately 240,000 to 250,000 over the period of 1998 to 2002 (4), and will continue to increase in the future, unless we can reduce the infection rate, or increase the cure rate."

"However, under current circumstances only approximately 6000 patients are treated each year"

"Clearly, these low cure rates mean that a large number of patients remain at risk for liver failure and hepatocellular carcinoma."

"It would be years before the limited number of treating physicians in Canada could deal effectively with the volume of patients in need of therapy."

"The figures given in the previous paragraphs are all estimates"

"The official ignorance regarding this important disease is part of a circle of neglect. The costs, and mortality and morbidity rates of hepatitis C do not cause alarm because they are below the radar as the result of improper measurements. Conversely, the perception seems to be that we do not need to measure hepatitis C statistics accurately because the numbers that are available are not alarming."

"Care for patients with hepatitis is provided by the fewer than 100 hepatologists in Canada, some infectious disease physicians, gastroenterologists and internists, and a small number of family practitioners. Overall, there are probably not more than about 300 physicians in Canada who are providing treatment for hepatitis C."

"The predicted increase in numbers of patients with the complications of hepatocellular carcinoma, who will require liver transplants will clearly outstrip our ability to provide care for these patients."

"Many experts have been predicting these grim scenarios for years. However, their warnings have for the most part fallen on deaf official ears. Experts have also recommended, for years, that hepatitis C needs a programmatic approach to decrease the rate of new infections, identify those already infected and provide effective therapy for those who need it."

Read the full editorial in The Canadian Journal of Gastroenterology Vol 22 No 4 April 2008

“A community of people with hepatitis C trying to help other people who are affected by hepatitis C”