Liver and Bile
Hepatology. 2022;75(5):1247–56
Favorable impact in hepatitis C-related mortality following free access to direct-acting antivirals in Spain
Background and aims: Free treatments for hepatitis C virus (HCV) infection with direct-acting antivirals became widespread in Spain in April 2015. The authors aimed to test whether, after this intervention, there was a more favorable change in population mortality from HCV-related than from non-HCV-related causes.
Approach and results: Post-intervention changes in mortality were assessed using uncontrolled before-after and single-group interrupted time series designs. All residents in Spain during 2001–2018 were included. Various underlying death causes were analyzed: HCV infection; other HCV-related outcomes (hepatocellular carcinoma [HCC], liver cirrhosis, and human immunodeficiency virus [HIV] disease); and non-C hepatitis, other liver diseases, and non-hepatic causes as control outcomes. Changes in mortality after the intervention were first assessed by rate ratios (RRs) between the post-intervention and pre-intervention age-standardized mortality rates. Subsequently, using quasi-Poisson segmented regression models, the annual percent change (APC) in mortality rate in the post-intervention and pre-intervention periods was estimated. All mortality rates were lower during the post-intervention period, although RRs were much lower for HCV (0.53; 95% confidence interval [CI]: 0.51–0.56) and HIV disease than other causes. After the intervention, there was a great acceleration of the downward mortality trend from HCV, whose APC went from -3.2% (95% CI: -3.6% to -2.8%) to -18.4% (95% CI: -20.6% to -16.3%). There were also significant accelerations in the downward trends in mortality from HCC and HIV disease, while they remained unchanged for cirrhosis and slowed or reversed for other causes.
Conclusions: These results suggest that the favorable changes in hepatitis C virus (HCV)-related mortality observed for Spain after April 2015 are attributable to scaling up free treatment with direct-acting antivirals and re-inforce that HCV eradication is on the horizon.