METHODS
Decision Analytic Model
We programmed (Microsoft Visual Studio 2008, Redmond, Washington) a Markov chain Monte Carlo simulation model of the prevalence of hepatitis C antibody stratified by age, sex, race/ethnicity, and history of injection-drug use and of the natural history of chronic hepatitis C. Amore thorough description of the disease components is provided elsewhere (5). Briefly, we modeled chronic HCV infection based on Meta-Analysis of Histologic Data in Viral Hepatitis (METAVIR) scale units (24). We stratified annual disease progression by age at infection, sex, and
alcohol consumption history and determined disease progression at model initiation by using historical HCV incidence data and published observations of annual progression in METAVIR units (Supplement 1, available at www.annals.org) (2, 25). Patients who progressed to a METAVIR score of 4 were classified as having cirrhosisnd experienced subsequent annual probability of 0.039 for progressing to decompensated cirrhosis (DCC) and a probability of 0.025 for developing hepatocellular carcinoma (HCC) (3, 26). Patients with DCC or HCC experienced an annual probability of transplantation or death (27–29). Data reported in Supplement 1 were obtained from multiple sources (30–48).
METHODSDecision Analytic ModelWe programmed (Microsoft Visual Studio 2008, Redmond, Washington) a Markov chain Monte Carlo simulation model of the prevalence of hepatitis C antibody stratified by age, sex, race/ethnicity, and history of injection-drug use and of the natural history of chronic hepatitis C. Amore thorough description of the disease components is provided elsewhere (5). Briefly, we modeled chronic HCV infection based on Meta-Analysis of Histologic Data in Viral Hepatitis (METAVIR) scale units (24). We stratified annual disease progression by age at infection, sex, andalcohol consumption history and determined disease progression at model initiation by using historical HCV incidence data and published observations of annual progression in METAVIR units (Supplement 1, available at www.annals.org) (2, 25). Patients who progressed to a METAVIR score of 4 were classified as having cirrhosisnd experienced subsequent annual probability of 0.039 for progressing to decompensated cirrhosis (DCC) and a probability of 0.025 for developing hepatocellular carcinoma (HCC) (3, 26). Patients with DCC or HCC experienced an annual probability of transplantation or death (27–29). Data reported in Supplement 1 were obtained from multiple sources (30–48).
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