1. More than half a million individuals in Taiwan experience chronic HCV infection (1). Nosocomial transmission has been minimized after the implementation of blood screening in 1992 (expert input). The percent of HCV infections due to injection drug use (IDU) is growing (expert input) from an estimated 7.3% in 2002 (3). Incidence of HCV began to increase shortly after WWII and most infections occurred before blood screening in 1992 (4). HCV prevalence is decreasing overtime, a trend which is most likely attributed to a high mortality rate due to an older patient population (expert input). New direct-acting antivirals (DAA) achieve higher sustained viral response rates (SVR) than the current treatment paradigms. Assessing potential disease control strategies requires epidemiological data and modeling to project the impact of new treatments. Infected population and disease progression were modeled using age-and gender-defined cohorts to track HCV incidence, prevalence, morbidity and mortality (5). Model inputs for prevalence, age, gender and genotype distribution, diagnosis, liver transplants and mortality risk factors were derived from Taiwanese data sources identified in a literature review and in discussions with local clinical and research experts (Table) (1-4, 6-8). Model was validated using reported hepatocellular carcinoma (HCC) and assumptions for the proportion of HCC cases attributable to HCV infection (4, 9). The Base scenario maintained the same assumptions as today into the future (Table)—Annual treated population (8,060 treated) and SVR (67%) held constant during 2014-2030. Two additional scenarios were developed using SVR, numbers annually treated and diagnosed, age and fibrosis stage restrictions, and medical eligibility as variables (Figure 1). The prevalence of HCV-related morbidity and mortality in 2030 were projected for each scenario and the results were compared to the base case model results (Figure 3). Disease Burden of Chronic Hepatitis C Virus (HCV) Infection in Taiwan Chien-Jen Chen 1, Wan-Long Chuang 2, Mei-Hsuan Lee 3, Pei-Jer Chen 4, Rong-Nan Chien 5, Ching-Chih Hu 5, Chung-Feng Huang 2, Jonathan Schmelzer 6, Tung-Hung Su 7, Homie Razavi 6, Jia-Horng Kao 7 1 Genomics Research Center, Academia Sinica, Taipei, Taiwan 2 Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung City, Taiwan 3 Institute of Clinical Medicine, National Yang-Ming University, Taipei, Taiwan 4 Hepatitis Research Center, National Taiwan University, Taipei, Taiwan 5 Liver Research Unit, Keelung Chang Gung Memorial Hospital, Keelung, Taiwan 6 Center for Disease Analysis, Lafayette, Colorado, United States 7 Department of Internal Medicine, National Taiwan University Hospital, Taipei City, Taiwan Background Base Case Viremic infections decline to 293,000 in 2030 as compared to 522,000 in 2014 (44% decrease), mostly as a result of high mortality in an aging population (Figure 2). In 2014, over 70% of the infected population was estimated to be born prior to 1962. By 2030 prevalent compensated and decompensated cirrhosis will decline by 24% and 14%, respectively, as compared to 2014 (Figure 2). By 2030, annual HCV-related liver deaths will decrease by 16% as compared to 2014, from 6,220 deaths to 5,260 deaths (Figure 3). In 2030, HCC cases are projected at 5,600, a decrease of 18% as compared to 2014 (6,830 cases). Scenario 1—Same assumptions as Base but increased SVR (97%) and expanded age eligibility (15-84 years) Chronic infections were estimated at 271,000 in 2030 (8% less than the base scenario projection), and total HCC cases were projected to decline to 4,830 by 2030 (12% less than the base scenario projection) (Figure 3). Liver-related deaths, compensated and decompensated cirrhosis were each projected at 14% less than base scenario projections in 2030. Scenario 2—Increased SVR (97%), numbers treated and diagnosed, and medical eligibility; relaxed restrictions on age and fibrosis Viremic cases in 2030 were estimated at 39,600 (87% less than the base scenario projection in 2030 and a 92% decrease from 2014). By 2030, HCC, decompensated and compensated cirrhosis cases would be 79%, 74% and 80% less than base scenario projections, respectively (Figure 3). Liver-related deaths were estimated at 1,260 in 2030, 76% fewer than the base scenario projection (Figure 3). Total viremic prevalence will decline significantly by 2030, due to fewer new infections and aging of the infected population, however advanced liver-related disease and mortality will decline at slower rates as disease progresses in those already infected. The results of Scenario 1 demonstrate that increased SVR alone will have little impact on the disease burden, even while expanding treatment to older patients. The results of Scenario 2 show that elimination of HCV (>90% reduction in total infections) is achieved by 2030 in the model with a nearly 4-fold increase in annual number treated. An elimination strategy would likely require a screening program to identify enough patients to treat. The projected impact of the scenarios will inform disease forecasting, resource planning, and intervention strategies for HCV in Taiwan. 1. Yu ML, Yeh ML, Tsai PC, Huang CI, Huang JF, Huang CF, Hsieh MH, Liang PC, Lin YH, Hsieh MY, Lin WY, Hou NJ, Lin ZY, Chen SC, Dai CY, Chuang WL, and Chang WY. 2015. Huge Gap Between Clinical Efficacy and Community Effectiveness in the Treatment of Chronic Hepatitis C: A Nationwide Survey in Taiwan. Medicine 94 (13). 2. Sun CA, Chen HC, Lu CF, You SL, Mau YC, Ho MS, Lin SH, Chen CJ. Transmission of hepatitis C virus in Taiwan: prevalence and risk factors based on a nationwide survey. J Med Virol 1999 November;59(3):290-6. 3. Aceijas C, Rhodes T. Global estimates of prevalence of HCV infection among injecting drug users. Int.J.Drug Policy 2007 Oct;18(5):352-8 4. McEwan P, Ward T, Chen CJ, Lee MH, Yang HW, Kim R, et al. Estimating the Incidence and Prevalence of Chronic Hepatitis C Infection in Taiwan Using Back Projection. Value in Health Regional Issues 2014 May;3: 5-11. 5. Sibley A, Han KH, Abourached A, Lesmana LA, Makara M, Jafri W, et al. The present and future disease burden of hepatitis C virus infections with today's treatment paradigm - volume 3. J Viral Hepat. 2015;22 Suppl 4:21-41. 6. Chen CH, Yang PM, Huang GT, Lee HS, Sung JL, and Sheu JC. Estimation of Seroprevalence of Hepatitis B Virus and Hepatitis C Virus in Taiwan from a Large-scale Survey of Free Hepatitis Screening Participants. Journal of the Formosan Medical Association 2007; 106 (2): 148-155. 7. Lee CM, Lu SN, Hung CH, Tung WC, Wang JH, Tung HD, et al. Hepatitis C virus genotypes in southern Taiwan: prevalence and clinical implications. Trans R Soc Trop Med Hyg 2006 Aug;100(8):767-74. 8. Sievert W, Altraif I, Razavi HA, Abdo A, Ahmed EA, Al Omair A, et al. A systematic review of hepatitis C virus epidemiology in Asia, Australia and Egypt. Liver Int 2011 Jul;31 Suppl 2:61-80. 9. Lu SN, Su WW, Yang SS, Chang TT, Cheng KS, Wu JC, et al. Secular trends and geographic variations of hepatitis B virus and hepatitis C virus-associated hepatocellular carcinoma in Taiwan. International journal of cancer Journal international du cancer. 2006;119(8):1946-52. Table. Model inputs and 2014 estimates Methods References Results Conclusions Contact Information: homie.razavi@centerforda.com Disclosures: This project was funded through grant support provided by Gilead Sciences, Inc. Homie Razavi and Jonathan Schmelzer are employees of Center for Disease Analysis. Figure 3. Selected HCV-related outcomes by scenario – Taiwan, 2014-2030 Figure 1. Scenario 2 Inputs – Taiwan, 2014-2030 Objectives Use a modeling approach to examine HCV- related disease progression over time. Compare the impact of two scenarios on disease burden with the current status quo: Scenario 1: Treat same number of patients with higher SVR (97%) among patients age 15-84 years starting in 2016 Scenario 2: Increase SVR to 97% in 2016 and gradually expand treatment to 34,000 annually by 2025 Figure 2. Base case model outputs – Taiwan, 1950-2030 Leave blank for poster number