Feasibility of reaching world health organization targets for hepatitis C and the cost‐effectiveness of alternative strategies

Abstract

Summary New drugs for treating hepatitis C have considerably increased the probability of being cured. Treatment uptake, however, is still low. The objectives of this study were to analyse the impact of initiatives that may increase the proportion of infected people on treatment and interventions aimed at reducing the incidence of new infection among people who inject drugs. A compartmental model for Norway was used to simulate hepatitis C and related complications. We analysed 2 different screening initiatives aimed to increase the proportion of infected people on treatment. Interventions aiming at reducing the hepatitis C incidence analysed were opioid substitution therapy (OST), a clean needle and syringe programme and a combination of both. The most cost‐effective strategy for increasing hepatitis C treatment uptake was screening by general practitioners while simultaneously allowing for all infected people to be treated. We estimated that this intervention reduces the incidence of hepatitis C by 2030 by 63% compared with the current incidence. The 2 harm reduction strategies both reduced the incidence of hepatitis C by about 70%. Combining an increase in the current clean needles and syringe programme with OST was clearly the most cost‐effective option. This strategy would reduce the incidence of hepatitis C by 80% compared with the current incidence by 2030. Thus, interventions to reduce the burden and spread of hepatitis C are cost‐effective. Reaching the WHO target of a 90% reduction in hepatitis C incidence by 2030 may be difficult without combining different initiatives.

Systematic review: economic evaluations of HCV screening in the direct‐acting antivirals era

“…Seventeen studies assessed the costs and effects of screening programs and antiviral treatments: seven evaluated screening in general population or subgroup of general population, five in people who inject drugs, four in high‐risk populations and three in other populations . It is to be noted here that two studies evaluated the cost‐effectiveness of HCV screening in more than one population group (general and high‐risk population, and people who inject drugs and high‐risk population).…”

“…Four studies included in this group were cost‐utility analysis and estimated the ICER as € per QALY gained, and one study was a cost‐effectiveness analysis with the ICER reported as € per life year saved (Table S3). One study was multi‐country and assessed the screening programs in five Eastern Europe countries .…”

“…Two studies assessed only the HCV screening‐treatment cost and effectiveness . One study assessed separately the effect of HCV screening and treatment, and the effect of opioid substitution therapy and clean needle and syringe program . Another study assessed 11 possible screening strategies, treatments and harm reduction interventions for HCV and HIV infection …”

“…The results of all studies reported the screening strategies as a cost‐effectiveness option in the people who inject drugs population (Table S3). All studies concluded that screening and DAAs treatment is not generally sufficient to eliminate the HCV infection, and only the combination with additional interventions, such as opioid substitution therapy, clean needle and syringe program and education, has the potential to be successful in the people who inject drugs population . Screening combined with education and care coordination for all HCV infected subjects was the most cost‐effectiveness strategy compared to no intervention, program based on only screening or program based on screening plus education .…”

“…All studies conducted on the general population and high‐risk populations reported a moderate‐good quality when evaluated with the CHEERS checklist, with some issues associated with the description of the study perspective and the analytic method applied (Figure S2). Furthermore, three studies on the people who inject drugs population reported issues in the quality of the paper; while a better quality was reported by the other two (Figure S2). In the studies conducted in the other population groups, two studies reported particular issues associated to the method items (Figure S2).…”