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To the Editor: In their evaluation of the cost-effectiveness of treatment for chronic hepatitis C infection, Dr Salomon and colleagues¹ pointed out that their findings are highly sensitive to alternative assumptions of the effect of both chronic HCV infection and treatment on quality of life.¹ The importance of quality-of-life parameters to their models is largely due to the small proportion of their baseline cohort—40-year-old patients with chronic HCV infection—that is estimated to progress to advanced liver disease-related complications.

We have recently reported a systematic review of studies of the natural history of HCV infection,² as well as a model of its natural history.³ These analyses suggest an even slower disease progression than Salomon et al used in their analyses. Based on our models, 12% of people with chronic HCV infection and no hepatic fibrosis would progress to cirrhosis after 30 years, nearly half the 20% estimate of Salomon et al. . . . [Full Text of this Article]

Gregory J. Dore, MD, MPH, PhD; Hla-Hla Thein, MD, MPH
Viral Hepatitis Program
National Centre in HIV Epidemiology and Clinical Research
University of New South Wales
Sydney, Australia

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