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Medical Decision Making
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Estimating the Prognosis of Hepatitis C Patients Infected by Transfusion in Canada between 1986 and 1990

Murray Krahn, MD, MSc

Toronto General Hospital, ES9 408, 200 Elizabeth Street, Toronto, Ontario M5G 2C4, Canada; murray.krahn{at}uhn.on.ca

John B. Wong, MD

Jenny Heathcote, MD

Linda Scully, MD

Leonard Seeff, MD

Objective.To develop a natural history model for chronic hepatitis C virus (HCV) infection to determine allocation of compensatory funds to Canadians who acquired HCV through the blood supply from 1986 through 1990.Methods. A Markov cohort simulation model for HCV prognosis was developed, using content experts, published data, posttransfusion look-back data, and a national survey. Results.The mortality rate in transfusees is high (46% at 10 years), although HCV-related deaths are rare. Only 14% develop-cirrhosis at 20 years (95% confidence interval, 0%–-44%), but 1 in 4 will eventually develop cirrhosis, and 1 in 8 will die of liver disease.Conclusions.This unique application of Markov cohort simulation and epidemiologic methods provides a state-of-the-art estimate ofHCVprognosis and has allowed compensation decisions to be based on the best available evidence.

Key Words: hepatitis C • Markov model • decision making

Medical Decision Making, Vol. 24, No. 1, 20-29 (2004)
DOI: 10.1177/0272989X03261568
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