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

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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

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Cost-Benefit Analysis
Antiviral Agents
Fibrosis
Pharmaceutical Preparations
Therapeutics
Quality-Adjusted Life Years
Costs and Cost Analysis
Interferons
Genotype
Drug Costs
Health Care Costs

Keywords

  • hepatitis C
  • antiviral therapy
  • HCV transmission

Cite this

Martin, N. K., Vickerman, P., Dore, G. J., Grebely, J., Miners, A., Cairns, J., ... Hickman, M. (2016). Prioritization of HCV treatment in the direct-acting antiviral era: an economic evaluation. Journal of Hepatology, 65(1), 17–25. https://doi.org/10.1016/j.jhep.2016.02.007
Martin, Natasha K. ; Vickerman, Peter ; Dore, Gregory J. ; Grebely, Jason ; Miners, Alec ; Cairns, John ; Foster, Graham R. ; Hutchinson, Sharon J. ; Goldberg, David J. ; Martin, Thomas C.S. ; Ramsay, Mary ; Hickman, Matthew. / Prioritization of HCV treatment in the direct-acting antiviral era: an economic evaluation. In: Journal of Hepatology. 2016 ; Vol. 65, No. 1. pp. 17–25.
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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.",
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Martin, NK, Vickerman, P, Dore, GJ, Grebely, J, Miners, A, Cairns, J, Foster, GR, Hutchinson, SJ, Goldberg, DJ, Martin, TCS, Ramsay, M & Hickman, M 2016, 'Prioritization of HCV treatment in the direct-acting antiviral era: an economic evaluation', Journal of Hepatology, vol. 65, no. 1, pp. 17–25. https://doi.org/10.1016/j.jhep.2016.02.007

Prioritization of HCV treatment in the direct-acting antiviral era: an economic evaluation. / Martin, Natasha K.; Vickerman, Peter; Dore, Gregory J.; Grebely, Jason ; Miners, Alec; Cairns, John; Foster, Graham R.; Hutchinson, Sharon J.; Goldberg, David J.; Martin, Thomas C.S.; Ramsay, Mary; Hickman, Matthew.

In: Journal of Hepatology, Vol. 65, No. 1, 07.2016, p. 17–25.

Research output: Contribution to journalArticle

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T1 - Prioritization of HCV treatment in the direct-acting antiviral era: an economic evaluation

AU - Martin, Natasha K.

AU - Vickerman, Peter

AU - Dore, Gregory J.

AU - Grebely, Jason

AU - Miners, Alec

AU - Cairns, John

AU - Foster, Graham R.

AU - Hutchinson, Sharon J.

AU - Goldberg, David J.

AU - Martin, Thomas C.S.

AU - Ramsay, Mary

AU - Hickman, Matthew

N1 - Acceptance from webpage. OA article funded by MRC 2016 The Authors. Published by Elsevier B.V. on behalf of the European Association for the Study of the Liver. This is an open access article under the CC BY license (http://creativecommons. org/licenses/by/4.0/).

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N2 - 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.

AB - 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.

KW - hepatitis C

KW - antiviral therapy

KW - HCV transmission

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DO - 10.1016/j.jhep.2016.02.007

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SP - 17

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Martin NK, Vickerman P, Dore GJ, Grebely J, Miners A, Cairns J et al. Prioritization of HCV treatment in the direct-acting antiviral era: an economic evaluation. Journal of Hepatology. 2016 Jul;65(1):17–25. https://doi.org/10.1016/j.jhep.2016.02.007