Abstract
ObjectiveThe prevalence of the hepatitis C virus (HCV) remains high amongst people who inject drugs (PWID) and accounts for the majority of newly acquired infections. This study aims to quantify the value of treatment amongst PWID with more efficacious treatments and at increased uptake rates, with respect to the avoidance of future infections and subsequent long-term complications of HCV.MethodsA dynamic HCV transmission and disease progression model was developed, incorporating acute and chronic infection and their long-term complications (decompensated cirrhosis, cancer, liver transplant and mortality), with the potential for HCV transmission to other PWID prior to successful treatment. The model was populated with prevalence and therapy data from a UK setting. Scenarios of current standard of care (SoC) treatment efficacy and uptake were compared to anticipated sustained virologic response (SVR) rates of 90–100% and increased uptake over varied horizons.ResultsSoC led to modest reductions in prevalence; >5% after 200 years. New treatments achieving 90% SVR could reduce prevalence below 5% within 60 years at current uptake rates or within 5 years if all patients are treated. Amongst 4,240 PWID, chronic HCV infections avoided as a result of increasing treatment uptake over the period 2015–2027 ranged from 20–580 and 34–912 with SoC and 90% SVR rates respectively. The reduction in downstream HCV infections due to increasing treatment uptake resulted in an approximate discounted gain of 300 life-years (from avoiding reduced life expectancy from HCV infection) and a gain of 1,700 QALYs (from avoiding the disutility of HCV infection and related complications), with a projected £5.4 million cost saving.ConclusionWhile improved SVR profiles led to reductions in modelled prevalence, increased treatment uptake was the key driver of future infections avoided. Increased treatment among PWID with new more efficacious therapies could significantly change the future dynamics, cost and health burden of HCV-related disease.
Highlights
The sharing of needles and other injection paraphernalia among injecting drug users is one of the highest risk factors for acquiring the hepatitis C virus (HCV)
While improved sustained virologic response (SVR) profiles led to reductions in modelled prevalence, increased treatment uptake was the key driver of future infections avoided
Figures are similar in other regions of the UK: in 2012, 49%, 33% and 34% of current and former People who inject drugs (PWID) participating in the Unlinked Anonymous Monitoring (UAM) survey in England, Wales and Northern Ireland, respectively, tested positive for antibodies to HCV [7]
Summary
The sharing of needles and other injection paraphernalia among injecting drug users is one of the highest risk factors for acquiring the hepatitis C virus (HCV). Figures are similar in other regions of the UK: in 2012, 49%, 33% and 34% of current and former PWID participating in the Unlinked Anonymous Monitoring (UAM) survey in England, Wales and Northern Ireland, respectively, tested positive for antibodies to HCV [7]. These figures demonstrate that behavioural interventions alone are unlikely to alter the prevalence of HCV and highlight the important role that HCV treatment may play in the prevention of future disease transmission
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