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J Hepatol. 2016 Jul;65(1):17-25. doi: 10.1016/j.jhep.2016.02.007. Epub 2016 Feb 8.

Prioritization of HCV treatment in the direct-acting antiviral era: An economic evaluation.

Author information

1
Division of Global Public Health, University of California San Diego, San Diego, USA; School of Social and Community Medicine, University of Bristol, UK. Electronic address: Natasha-martin@ucsd.edu.
2
School of Social and Community Medicine, University of Bristol, UK.
3
Kirby Institute, UNSW Australia, Sydney, Australia.
4
Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, UK.
5
Queen Mary's University of London, UK.
6
Glasgow Caledonian University, UK; Health Protection Scotland, UK.
7
Guy's and St Thomas's NHS Foundation Trust, London, UK.
8
Public Health England, UK.

Abstract

BACKGROUND & AIMS:

We determined the optimal HCV treatment prioritization strategy for interferon-free (IFN-free) HCV direct-acting antivirals (DAAs) by disease stage and risk status incorporating treatment of people who inject drugs (PWID).

METHODS:

A dynamic HCV transmission and progression model compared the cost-effectiveness of treating patients early vs. delaying until cirrhosis for patients with mild or moderate fibrosis, where PWID chronic HCV prevalence was 20, 40 or 60%. Treatment duration was 12weeks at £3300/wk, to achieve a 95% sustained viral response and was varied by genotype/stage in alternative scenarios. We estimated long-term health costs (in £UK=€1.3=$1.5) and outcomes as quality adjusted life-years (QALYs) gained using a £20,000 willingness to pay per QALY threshold. We ranked strategies with net monetary benefit (NMB); negative NMB implies delay treatment.

RESULTS:

The most cost-effective group to treat were PWID with moderate fibrosis (mean NMB per early treatment £60,640/£23,968 at 20/40% chronic prevalence, respectively), followed by PWID with mild fibrosis (NMB £59,258 and £19,421, respectively) then ex-PWID/non-PWID with moderate fibrosis (NMB £9,404). Treatment of ex-PWID/non-PWID with mild fibrosis could be delayed (NMB -£3,650). In populations with 60% chronic HCV among PWID it was only cost-effective to prioritize DAAs to ex-PWID/non-PWID with moderate fibrosis. For every one PWID in the 20% chronic HCV setting, 2 new HCV infections were averted. One extra HCV-related death was averted per 13 people with moderate disease treated. Rankings were unchanged with reduced drug costs or varied sustained virological response/duration by genotype/fibrosis stage.

CONCLUSIONS:

Treating PWID with moderate or mild HCV with IFN-free DAAs is cost-effective compared to delay until cirrhosis, except when chronic HCV prevalence and reinfection risk is very high.

KEYWORDS:

Hepatitis C; People who inject drugs; Prevention; Treatment

PMID:
26867489
PMCID:
PMC4914770
DOI:
10.1016/j.jhep.2016.02.007
[Indexed for MEDLINE]
Free PMC Article

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