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Research
Forecasted impacts of a sofosbuvir-based national hepatitis C treatment programme on Egypt’s hepatocellular cancer epidemic: simulation of alternatives
  1. Wenkang Ma1,
  2. Amr S Soliman2,
  3. Wagida A Anwar3,
  4. Ahmed Hablas4,
  5. Tamer B El Din5,
  6. Mohamed Ramadan4,
  7. Ibrahim A Seifeldin4,
  8. Mark L Wilson1
  1. 1Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, Michigan, USA
  2. 2Department of Community Health and Social Medicine, City University of New York School of Medicine, New York, USA
  3. 3Department of Community, Environmental and Occupational Medicine, Faculty of Medicine, Ain Shams University, Cairo, Egypt
  4. 4Gharbiah Cancer Registry and Tanta Cancer Center, Tanta, Egypt
  5. 5HEOR, Cairo, Egypt
  1. Correspondence to Professor Mark L Wilson; wilsonml{at}umich.edu

Abstract

Background Egypt is experiencing a hepatocellular cancer (HCC) epidemic due to widespread hepatitis C virus (HCV) transmission. The use of sofosbuvir-related therapies producing improved treatment success has permitted an updated, nationwide, HCV treatment programme with expanded coverage. This study simulated the multidecade impacts of the new treatment programme on hepatitis and HCC.

Methods A Markov model of HCV infection and treatment analysed the HCV-related HCC epidemic between 2009 and 2050, using parameters based on peer-reviewed studies and expert opinion. Comparing the ‘new’ and ‘old’ scenarios, and with the old treatment programme being replaced or not by the new programme in 2015, the annual number, prevalence and incidence of HCC were simulated for representative Egypt populations including HCV-infected patients aged 15–59 years in 2008, healthy people aged 5–59 years in 2008 and 5-year-old children cohorts entering the population each year beginning in 2009. Averted HCC cases were calculated, and sensitivity analyses were performed.

Results Compared with the old scenario, the estimated number, prevalence and incidence of future HCC cases in the new scenario would peak earlier and at lower levels in 2025 (~29 000), 2023 (~28/100 000) and 2022 (~14/100 000), respectively. The new treatment programme is estimated to avert ~956 000 HCC cases between 2015 and 2050.

Discussion By reducing cancer cases and shortening the peak epidemic period, the new programme should substantially diminish the HCC epidemic across Egypt. Our timeline forecast for Egypt’s HCC epidemic, and evaluation of various disease and programme components, should be useful to other countries that are developing policies to address HCV-related liver cancer prevention.

  • Liver cancer
  • hepatocellular cancer
  • hepatitis C
  • HCV
  • disease burden
  • simulation

This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/

https://doi.org/10.1136/bmjgh-2017-000572

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    Footnotes

    • Handling editor Seye Abimbola

    • Contributors WM, ASS, WAA and MLW contributed to the conception and design of the study. AH, MR and IAS monitored the field surveillance and integrity of the data. WM and AH. MR and IAS were involved in data acquisition and management. TBED contributed to the understanding of current pattern of hepatitis C treatment in Egypt. WM and MLW were responsible for statistical analysis, interpretation and the report draft. All authors contributed to revisions and the final version.

    • Funding This study was funded by University of Michigan Office of Global Health. This study also received funds from Cancer Epidemiology Education in Special Populations (CEESP) Program of the National Cancer Institute (Grant R25 CA112383).

    • Competing interests None declared.

    • Patient consent Not required.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Data sharing statement Model files and data available on request.