Mortality and morbidity related to hepatitis C virus infection in hospitalized adults-A propensity score matched analysis.

The World Health Organization (WHO) aims to reduce HCV mortality, but estimates are difficult to obtain. We aimed to identify electronic health records of individuals with HCV infection, and assess mortality and morbidity. We applied electronic phenotyping strategies on routinely collected data from patients hospitalized at a tertiary referral hospital in Switzerland between 2009 and 2017. Individuals with HCV infection were identified using International Classification of Disease (ICD)-10 codes, prescribed medications and laboratory results (antibody, PCR, antigen or genotype test). Controls were selected using propensity score methods (matching by age, sex, intravenous drug use, alcohol abuse and HIV co-infection). Main outcomes were in-hospital mortality and attributable mortality (in HCV cases and study population). The non-matched dataset included records from 165,972 individuals (287,255 hospital stays). Electronic phenotyping identified 2285 stays with evidence of HCV infection (1677 individuals). Propensity score matching yielded 6855 stays (2285 with HCV, 4570 controls). In-hospital mortality was higher in HCV cases (RR 2.10, 95%CI 1.64 to 2.70). Among those infected, 52.5% of the deaths were attributable to HCV (95%CI 38.9 to 63.1). When cases were matched, the fraction of deaths attributable to HCV was 26.9% (HCV prevalence: 33%), whilst in the non-matched dataset, it was 0.92% (HCV prevalence: 0.8%). In this study, HCV infection was strongly associated with increased mortality. Our methodology may be used to monitor the efforts towards meeting the WHO elimination targets and underline the importance of electronic cohorts as a basis for national longitudinal surveillance.

How to set the agenda for hepatitis C: a theory-driven policy analysis.

BACKGROUND: Hepatitis C virus (HCV) represents a significant public health burden. When new HCV drugs arrived in 2014, the disease became curable, but the administration remained reluctant to address this public health issue. However, the Swiss parliament recently decided to integrate HCV into the next national HIV programme. This study investigates how HCV came onto the political agenda in Switzerland and which actors and factors were influential in this process. METHODS: The data collection is based on document analysis and semi-structured interviews. The transcripts were coded by deriving the codes from the data in terms of content followed by the application of the multiple streams framework. RESULTS: Health authorities, unlike experts, did not see the HCV epidemic as a relevant public health threat. Due to cost-related restriction of access to treatment, the potential of the new HCV drugs could not be fully exploited. The administration's position proved difficult to change, despite evidence to the contrary. For 30 years, authorities set the agenda in health policy regarding HCV, unheeded by politicians. But recently, a policy entrepreneur has for the first time successfully managed to put HCV on the political agenda. After years of education and lobbying, it used the window of opportunity in the form of the new edition of the national HIV programme. The parliamentary decision to include HCV in this programme broke the long-standing primacy of the administration in the field of HCV, which had long prevented a more active handling of the HCV field. CONCLUSIONS: The case of HCV in Switzerland shows that evidence alone is not enough to bring about health policy changes. A policy entrepreneur is needed who overcomes resistance, brings together the three streams-problem, policy and political-and exploits the window of opportunity at the right time. To be successful, the policy entrepreneur must identify the indicators that map the problem, network and convince decision-makers, recognize policy windows and use them-as has been the case with HCV in Switzerland.

The Swiss Hepatitis Strategy as a model for facing future health policy challenges.

Driven by the increasing evidence of the public health burden of viral hepatitis and the passivity of the health authorities, the Swiss Hepatitis Strategy (SHS) was launched by private initiative with the vision of eliminating viral hepatitis by 2030. The strategy applied the Governmental Learning Spiral method, an approach designed to overcome political barriers and to enhance innovation in the political context. This participative process, where those who develop are also those who implement, enhances a sense of social belonging among the people involved, which leads to the alignment of different viewpoints as well as to the creation of social networks. In consequence, a broader audience becomes involved; this creates feedback loops that lead to the continuous improvement of the strategy process. Within less than five years the SHS has been able to achieve significant goals within the scope of its vision: the implementation of universal access to Hepatitis C therapies has been enforced; increased attention within the general population has been achieved by using progressively more media coverage about therapies, a patient organisation has been founded and the national health authorities have begun to support the strategy financially. The case of the SHS proves, that a carefully designed political learning process is an efficient and innovative tool in the face of today's health policy challenges such as the Hepatitis C epidemic.