Scott, Nick, McBryde, Emma S., Thompson, Alexander, Doyle, Joseph S., and Hellard, Margaret E. (2016) Treatment scale-up to achieve global HCV incidence and mortality elimination targets: a cost-effectiveness model. Gut. pp. 1-9.

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Abstract

Aims: The World Health Organisation's (WHO's) draft hepatitis C virus (HCV) elimination targets propose an 80% reduction in incidence and a 65% reduction in HCV-related deaths by 2030. We estimate the treatment scale-up required and cost-effectiveness of reaching these targets among injecting drug use (IDU)-acquired infections using Australian disease estimates.

Methods: A mathematical model of HCV transmission, liver disease progression and treatment among current and former people who inject drugs (PWID). Treatment scale-up and the most efficient allocation to priority groups (PWID or people with advanced liver disease) were determined; total healthcare and treatment costs, quality-adjusted life years (QALYs) and incremental cost-effectiveness ratios (ICERs) compared to inaction were calculated.

Results: 5,662 (95%CI 5,202-6,901) courses per year (30/1000 IDU-acquired infections) were required, prioritised to patients with advanced liver disease, to reach the mortality target. 4,725 (3,278-8,420) courses per year (59/1000 PWID) were required, prioritised to PWID, to reach the incidence target; this also achieved the mortality target, but to avoid clinically unacceptable HCV related deaths an additional 5,564 (1,959-6,917) treatments per year (30/1000 IDU-acquired infections) were required for five years for people with advanced liver disease. Achieving both targets in this way cost AUS$4.6 ($4.2-4.9) billion more than inaction, but gained 184,000 (119,000-417,000) QALYs, giving an ICER of AUS$25,121 ($11,062-39,036) per QALY gained.

Conclusions: Achieving WHO elimination targets with treatment scale-up is likely to be cost-effective, based on Australian HCV burden and demographics. Reducing incidence should be a priority to achieve both WHO elimination goals in the long-term.

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