Transcript Assessed for Rx 57% (32-70%)

Hepatitis C Needs Assessment:
Contributions from the
National HCV Diagnosis and
Local Clinical Databases
Key questions
1. How many people have been
diagnosed with HCV in Scotland?
2. How many people have attended a
clinic for HCV treatment/care?
3. How many people have been initiated
on HCV antiviral therapy?
4. How many patients have cleared HCV
from antiviral therapy?
1. How many people have been
diagnosed with HCV in Scotland?
Annual and cumulative HCV
diagnoses in Scotland (to 2006)
4000
New HCV diagnoses
3500
20000
3000
2500
15000
2000
10000
1500
1000
5000
500
0
0
1997
1998
1999
2000
2001
2002
2003
Year of HCV diagnosis
2004
2005
2006
Cumulative HCV diagnoses
25000
Characteristics of HCV diagnosed
persons in Scotland
(2003-2006, N = 6442)
• 66% male
• 22% 40 years at diagnosis; mean age = 34
• 90% current/former injecting drug users
• 55% genotype 2/3
• 50% of referrals were from hospitals,
24% from GPs, 6% GUM, 3% prisons
Cumulative HCV diagnoses by
NHS Board in Scotland
(to 2006)
0–249
250–749
Grampian
12%
Tayside
7%
750–1499
1500–4999
5000+
Lothian
14%
Greater
Glasgow
& Clyde
41%
N = 22,073
1. How many people have been
diagnosed with HCV in Scotland?
2. How many people have attended a
clinic for HCV treatment/care?
Locations of 16 HCV
treatment/care centres
Number of diagnoses
0–249
250–749
750–1499
1500–4999
5000+
Treatment centre
N = 22,073
Locations of HCV treatment/care
centres in relation to the HCV
diagnosed population
• Mean drive-time of 20 min. from HCV
diagnosed person’s place of residence
(postcode district) to the nearest HCV
treatment/care centre.
(range 10-80 min. for NHS Boards in
mainland Scotland)
Numbers of diagnosed HCV
attending HCV treatment/care centres
(to 2006)
Living
+ dead
Living
Diagnosed HCV antibody positive: 22,073
Diagnosed with chronic HCV (est.): 16,500
Attended specialist services for
chronic HCV (est.): 9,000
Diagnosed with chronic HCV (est.): 14,500
Ever chronic HCV and ever attended
specialist services (est.): 8,000
Approximately 55% of persons living with diagnosed
chronic HCV have ever been in specialist care
New attendees at HCV
treatment/care centres
(2003-2006, 5 clinics, N = 1202)
• 70% male
• 38% 40 years at first attendance;
mean age = 38
• 78% current/former injecting drug users
• 52% of referrals were from hospitals,
28% from GPs
• 92% PCR positive
New attendees at HCV
treatment/care centres
(2000-2005, 5 clinics, N = 1677)
• 2000-2005: 73% increase in new patients
(range 16-174%, 5 clinics)
Follow-up of new patients attending
HCV treatment/care centres
(2003-2005, 5 clinics, N = 964)
Not assessed for Rx
43%
New attendees
N=964
Assessed for Rx
57% (32-70%)
Most common
reason is failure
to attend
Follow-up of new patients attending
HCV treatment/care centres
(2003-2005, 5 clinics, N = 964)
Not assessed for Rx
43%
New attendees
Not suitable for Rx
N=964
32% (17-76%)
Assessed for Rx
57% (32-70%)
Most frequent:
• ongoing IDU
• chaotic lifestyle
Follow-up of new patients attending
HCV treatment/care centres
(2003-2005, 5 clinics, N = 964)
Not assessed for Rx
43%
New attendees
N=964
Assessed for Rx
57% (32-70%)
Approximately
20% refused or
deferred the offer
Suitable for Rx
68% (23-82%)
Follow-up of new patients attending
HCV treatment/care centres
(2003-2005, 5 clinics, N = 964)
Not assessed for Rx
43%
New attendees
Not suitable for Rx
N=964
32% (17-76%)
Assessed for Rx
57% (32-70%)
Suitable for Rx
68% (23-82%)
Approximately 30% of new attendees began therapy
1. How many people have been
diagnosed with HCV in Scotland?
2. How many people have attended a
clinic for HCV treatment/care?
3. How many people have been initiated
on HCV antiviral therapy?
Numbers of HCV diagnosed
persons initiated on antiviral therapy
(to 2006)
Living
+ dead
Diagnosed HCV antibody positive: 22,073
Diagnosed with chronic HCV (est.): 16,500
Attended specialist services for
chronic HCV (est.): 9,000
Initiated on antiviral therapy (est.): 2,300
Approximately 14% of persons who have ever
been diagnosed with chronic HCV have been initiated
on antiviral therapy
Patients initiated on HCV antiviral
therapy (2003-2006, 5 clinics, N = 353)
• 71% male
• 57% 40 years at initiation;
mean age = 41
• 56% injecting drug users
• 62% genotype 2/3
• 12% known to have cirrhosis
• 92% pegylated interferon +/- ribavirin
Patients initiated on HCV antiviral
therapy (2000-2005, 5 clinics, N = 678)
• 2000/1 to 2004/5: 117% increase in
number of patients initiating therapy
(range 50-208%, 5 clinics)
Key questions
1. How many people have been
diagnosed with HCV in Scotland?
2. How many people have attended a
clinic for HCV treatment/care?
3. How many people have been initiated
on HCV antiviral therapy?
4. How many patients have cleared HCV
from antiviral therapy?
Response to antiviral therapy
(2003-2006, 5 clinics, N = 286)
• 46% sustained viral response
• 43% no sustained viral response
• 11% incomplete
– major side effect: 52%
– patient request: 30%
– other: 18%
Current capacity of HCV
treatment/care centres (2006)
Number of patients attending HCV
treatment/care centres in 2006: 4,000
Number of patients initiated on antiviral
therapy in 2006 (est.): 450
Number of patients currently on waiting
list for therapy (est.): 330
Summary
• Estimated that 55% of people living with
chronic HCV have ever attended
specialist services
• Estimated that 14% of those with
diagnosed HCV have ever initiated therapy
• Annual numbers of new attendances and
therapy initiations are increasing
• Low completion of assessment (57%) is
an impediment to treatment