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( O. Baatarkhuu ),( M. Batzaya ),( S. Brandon ),( C. Estes ),( B. Chiang ),( J. Amaarsanaa ),( H. Razavi ),( P. Nymadawa ) 대한간학회 2018 춘·추계 학술대회 (KASL) Vol.2018 No.1
Aims: Mongolia has a large burden of viral hepatitis with the highest rates of liver cancer incidence and mortality In the world. An estimated 95% of liver cancer patients in Mongolia are infected with HCV and/or HBV. While HCV prevalence is likely declining, the burden of advanced liver disease will con tinue at a high level. Direct acting antivirals (DAAs) achieve higher sustained viral response rate (SVR) than interferon-based treatment regimens. In 2015, over 10,000 patients were treated in Mongolia with DAA regimens, an important first step on the path toward HCV elimination. Implementation of new treatments requires epidemiological data and modeling to as sess the potential impact of improved treatment strategies. Use a modeling approach to describe HCV-related disease progres sion at the national level in Mongolia through 2030. Consider the impact of two scenarios on disease burden: Base Scenario and WHO Targets 2030 Scenario. Methods: Disease progression used age-and gender-defined cohorts to track HCV incidence, prevalence, morbidity and mor tality. Data for prevalence, incidence, diagnosis, liver transplants and mortality risk factors were derived from Mongolian data sources when available, and expert consensus. A starting preva lence of 200,000 chronic cases in 2013 was used and was con sistent with adult prevalence estimates collected in prevalence surveys from 2005 and 2013, after adjustment for prevalence in younger age groups. Two scenarios were considered with one based on the status quo and another designed to achieve WHO 2030 goals. Base Scenario: Treat 10,300 =F2 patients in 2016, gradually declining to 1200 treated patients by 2030. As sume 3230 new infections and 1300 newly diagnosed annually. WHO Targets 2030 Scenario: Achieve 2030 WHO Global Health Sector Strategy on viral hepatitis including a diagnosis rate of 90%, 65% decrease in liver-related mortality and a 90% decrease in new infections by 2030. Achieved in Mongolia by increasing treatment to 10,000-15,000 =F0 cases annually, di agnosing up to 10,000 cases annually, and gradually reducing new infections to 300 annually by 2025 (90% reduction) (Figure 1). The incidence and prevalence of HCV-related morbidity and mortality through 2030 were projected. Results of the WHO Targets 2030 scenario were compared to the Base scenario. Results: Base Scenario Viremic infections decline to 141,000 in 2030 as compared to 188,000 in 2016 (25% decrease), largely due to mortality (Figure 2). By 2030 incident decompensated cirrhosis cases will decrease by 17% from 630 cases in 2016 to 520 cases in 2030. The number of incident HCC cases was projected at 650 in 2030, a decrease of 18% as compared to 2016 (800 cases). By 2030, annual HCV-related liver deaths will decrease by 28% as compared to 2016, from 1280 deaths to 920 deaths (Figure 2). There will be 13900 cumulative liver deaths during 2016-2030 (Figure 3). WHO Targets 2030 Scenario Chronic infections decline 87% during 2016-2030 from 188,000 cases to 24,100 cases. As compared to the Base Sce nario, cases decline by 83% in 2030. Incident HCC cases in 2030 were estimated at 170 respectively (74% decrease from Base Scenario. Incident liver deaths in 2030 were estimated at 330 (64% decrease from Base Scenario). During 2016-2030, there are a cumulative total of over 2800 fewer HCV-related deaths as compared to the Base Scenario. Conclusions: HCV disease is a substantial health burden in Mongolia, especially HCC and related deaths. Even under the Base Scenario, total viremic prevalence will decline by 2030, due to fewer new infections and mortality among an aging population. Scenario results emphasize the importance of in-creasing awareness, diagnosis and treatment of HCV, along with preventing new infections. Mongolia achieves WHO tar-gets for HCV hepatitis elimination by 2030 under the WHO Tar-gets 2030 Scenario, when including disease reduction achieved prior to 2016. The projected impact of the scenarios will facili-tate disease forecasting, resource planning, and rational strate-gies for HCV management in Mongolia.
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