Review for 10.1186/s12876-023-02750-2 (2023)

Title: The care cascade for hepatitis C virus and prognosis of chronic hepatitis C patients treated
with antiviral agents in a tertiary hospital
Version: 5 Date: 02 Mar 2023
Reviewer's report:
"PEER REVIEWER ASSESSMENTS:
OBJECTIVE - Full research articles: is there a clear objective that addresses one or several
testable research questions? (Brief or other article types: is there a clear objective?)
Yes - there is a clear objective
DESIGN - Is the current approach (including controls and analysis protocols) appropriate for
the objective?
Yes - the approach is appropriate
EXECUTION - Are the experiments and analyses performed with sufficient technical rigor to
allow confidence in the results?
Yes - experiments and analyses were performed appropriately
STATISTICS - Is the use of statistics in the manuscript appropriate?
Yes - appropriate statistical analyses have been used in the study
INTERPRETATION - Is the current interpretation/discussion of the results reasonable and not
overstated?
Yes - the author's interpretation is reasonable
OVERALL MANUSCRIPT POTENTIAL - Has the author addressed your concerns sufficiently
for you to now recommend the work as a technically sound contribution? If not, can further
revisions be made to make the work technically sound?
Yes - current version is technically sound
PEER REVIEWER COMMENTS:
GENERAL COMMENTS: Overall, this is a reasonably designed and reported study addressing
the outcomes of patients who were tested positive for HCV Ab at a single hospital between
2005-2020. In a sense, the authors are attempting to combine two analyses into one report, the
first examining the care of cascade for patients with chronic HCV, although fails to address
the denominator of at-risk patients who did not undergo screening, and the second examining
long-term clinical outcomes in patients with HCV, but does not directly compare treated versus
untreated patients, but rather on the basis of SVR/no SVR.  Although this study is relatively small
and does not significantly expand upon the existing literature addressing this topic compared
with large multicenter cohort studies, this does add important data specific to this population in
South Korea and may help inform guidelines and public health interventions in this region.
ADDITIONAL REQUESTS/SUGGESTIONS:
Overall the methodology, data presentation, and interpretation were sound.  The key limitations
in this analysis are non-modifiable due to intrinsic weaknesses of study population and
availability of data as clearly stated by previous reviewers.  My recommendation would be
for the authors to more clearly cite those limitations in the discussion section.  Few minor
queries: 1) methods: how was ""heavy alcohol consumption"" defined? (e.g. diagnosis codes); 2)
baseline evaluation: are fibrosis staging data available? the authors cite ultrasound for diagnosis
of cirrhosis, but was FIB-4, serum fibrosis assays, or elastography/LSM data collected? 3)
results/baseline characteristics: fatty liver/NAFLD and HIV are important covariates for HCV
outcomes - were these variables collected? 4) results/progress according treatment options? in a
typical cascade of care analysis, treatment initiation  and completion are analyzed, but only SVR
are reported - can the authors comment on the proportion of treated patients who did/did not
complete treatment? 5) results/cumulative incidence of cirrhosis/HCC: no correction requested
at this point but it's unfortunate the authors did not also examine other important outcomes such
as hepatic decompensation, liver-related mortality and/or all-cause mortality."