Abstract
In most developed countries, HCV is primarily transmitted by injecting drug users (IDUs). HCV antiviral treatment is effective, and deemed cost-effective for those with no re-infection risk. However, few active IDUs are currently treated. Previous modelling studies have shown antiviral treatment for active IDUs could reduce HCV prevalence, and there is emerging interest in developing targeted IDU treatment programmes. However, the optimal timing and scale-up of treatment is unknown, given the real-world constraints commonly existing for health programmes. We explore how the optimal programme is affected by a variety of policy objectives, budget constraints, and prevalence settings. We develop a model of HCV transmission and treatment amongst active IDUs, determine the optimal treatment programme strategy over 10 years for two baseline chronic HCV prevalence scenarios (30% and 45%), a range of maximum annual budgets (50,000–300,000 per 1,000 IDUs), and a variety of objectives: minimising health service costs and health utility losses; minimising prevalence at 10 years; minimising health service costs and health utility losses with a final time prevalence target; minimising health service costs with a final time prevalence target but neglecting health utility losses. The largest programme allowed for a given budget is the programme which minimises both prevalence at 10 years, and HCV health utility loss and heath service costs, with higher budgets resulting in greater cost-effectiveness (measured by cost per QALY gained compared to no treatment). However, if the objective is to achieve a 20% relative prevalence reduction at 10 years, while minimising both health service costs and losses in health utility, the optimal treatment strategy is an immediate expansion of coverage over 5–8 years, and is less cost-effective. By contrast, if the objective is only to minimise costs to the health service while attaining the 20% prevalence reduction, the programme is deferred until the final years of the decade, and is the least cost-effective of the scenarios.
Highlights
Hepatitis C virus (HCV) is a comparatively common bloodborne disease with 130–170 million people (2–3%) globally infected [1]
If the objective is to minimise health service costs and health utility loss related to HCV infection, Figure 1 shows the potential impact of the optimal treatment programmes for various maximum yearly programme budgets with a 30% baseline prevalence
The aim is to aid in the design and implementation of treatment programmes aimed at targeting active injecting drug users (IDUs) and utilising antiviral treatment as a prevention strategy
Summary
Hepatitis C virus (HCV) is a comparatively common bloodborne disease with 130–170 million people (2–3%) globally infected [1] It is one of the leading causes of chronic liver disease worldwide, and is the fastest growing cause of liver transplantation in developed countries [2]. In the UK, most developed countries, and many other developing countries without marked iatrogenic HCV risk (such as South Asia), over 80% of new cases are attributed to injecting drugs, with 15–90% of IDUs testing positive for HCV antibodies [4,5,6,7] Public health interventions such as health education and advice, needle and syringe exchange, and opiate substitution therapy aim to prevent transmission by reducing unsafe injecting [4]. Despite increases in intervention exposure, public health surveillance indicates that substantial decreases in HCV prevalence have not been achieved [8]
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