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

Natasha K. Martin*, Peter Vickerman, Gregory J. Dore, Jason Grebely, Alec Miners, John Cairns, Graham R. Foster, Sharon J. Hutchinson, David J. Goldberg, Thomas C.S. Martin, Mary Ramsay, Matthew Hickman

*Corresponding author for this work

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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 12 weeks 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.
Original languageEnglish
Pages (from-to)17–25
Number of pages9
JournalJournal of Hepatology
Volume65
Issue number1
Early online date8 Feb 2016
DOIs
Publication statusPublished - Jul 2016

Keywords

  • hepatitis C
  • antiviral therapy
  • HCV transmission

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