%0 Journal Article %A Sharon J Hutchinson %A Heather Valerio %A Scott A McDonald %A Alan Yeung %A Kevin Pollock %A Shanley Smith %A Stephen Barclay %A John F Dillon %A Raymond Fox %A Peter Bramley %A Andrew Fraser %A Nicholas Kennedy %A Rory N Gunson %A Kate Templeton %A Hamish Innes %A Allan McLeod %A Amanda Weir %A Peter C Hayes %A David Goldberg %T Population impact of direct-acting antiviral treatment on new presentations of hepatitis C-related decompensated cirrhosis: a national record-linkage study %D 2020 %R 10.1136/gutjnl-2019-320007 %J Gut %P 2223-2231 %V 69 %N 12 %X Objective Population-based studies demonstrating the clinical impact of interferon-free direct-acting antiviral (DAA) therapies are lacking. We examined the impact of the introduction of DAAs on HCV-related decompensated cirrhosis (DC) through analysis of population-based data from Scotland.Design Through analysis of national surveillance data (involving linkage of HCV diagnosis and clinical databases to hospital and deaths registers), we determined i) the scale-up in the number of patients treated and achieving a sustained viral response (SVR), and ii) the change in the trend of new presentations with HCV-related DC, with the introduction of DAAs.Results Approximately 11 000 patients had been treated in Scotland over the 8-year period 2010/11 to 2017/18. The scale-up in the number of patients achieving SVR between the pre-DAA and DAA eras was 2.3-fold overall and 5.9-fold among those with compensated cirrhosis (the group at immediate risk of developing DC). In the pre-DAA era, the annual number of HCV-related DC presentations increased 4.6-fold between 2000 (30) and 2014 (142). In the DAA era, presentations decreased by 51% to 69 in 2018 (and by 67% among those with chronic infection at presentation), representing a significant change in trend (rate ratio 0.88, 95% CI 0.85 to 0.90). With the introduction of DAAs, an estimated 330 DC cases had been averted during 2015–18.Conclusions National scale-up in interferon-free DAA treatment is associated with the rapid downturn in presentations of HCV-related DC at the population-level. Major progress in averting HCV-related DC in the short-term is feasible, and thus other countries should strive to achieve the same. %U https://gut.bmj.com/content/gutjnl/69/12/2223.full.pdf