State-transition model of the natural history of HCV. At any given time, a patient is represented by one of the health states, which are shown by squares. Arrows between states represent possible transitions based on annual probabilities. Patients whose disease is successfully treated transition to the SVR state. Patients who achieve SVR from F0 to F3 states are assumed to be cured; however, patients in an F4 state who are successfully treated transition to an F4-SVR state and may develop further complications. Patients in HCC, DC, and LT states have a higher mortality rate than the general population. All other patients have the same risk for death as the general population. The probability of death from other causes exists in every state, but deaths from other causes are not shown. According to the Meta-analysis of Histologic Data in Viral Hepatitis (METAVIR) scoring system, F0 indicates no fibrosis of the liver, F1 indicates portal fibrosis without septa, F2 indicates portal fibrosis with few septa, F3 indicates many septa without cirrhosis, and F4 indicates cirrhosis. DC, decompensated cirrhosis; LT, liver transplantation; SVR, sustained virologic response.

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Jagpreet Chhatwal, PhD 
MGH Inst. for Tech. Assessment 
Harvard Medical School 
101 Merrimac St. STE 1010 
Boston, MA 02114 United States

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Funding source: The creation of Hep C State Policy Simulator was supported by the Centers for Disease Control and Prevention through a Cooperative Agreement Number NU38OT000141 awarded to ChangeLab Solutions; and the National Science Foundation Award numbers 1722614, 1722665, and 1722906. Website's contents are solely the responsibility of the authors and do not necessarily represent the official views of the Centers for Disease Control and Prevention, the Department of Health and Human Services, or the National Science Foundation.

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