Treatment of Hepatitis C

Kohli, Anita; Shaffer, Ashton A.; Sherman, Amy C; Kottilil, Shyam

doi:10.1001/jama.2014.7085

Cited by 395 publications

(158 citation statements)

References 54 publications

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“…99 After 2015, we assumed that treatment would involve using the new direct-acting antiviral (DAA) drugs, and so assumed a high SVR rate of 90% for all genotypes. 103 Instantaneous HCV infection disease stage progression rates were calculated from a recent meta-analysis of PWID-specific progression probabilities to compensated cirrhosis 101 and a systematic review of general progression probabilities for other disease stages, 101 and, similarly, the spontaneous clearance probability came from a published meta-analysis. 96 Non-HCV-related death and injecting cessation were combined into one rate for each injecting duration strata, with the death rates being estimated from a cohort study of PWID in Scotland, 91 and the cessation rates being estimated through fitting the model to the observed distribution of PWID by injecting duration.…”

Section: Model Parameterisationmentioning

confidence: 99%

Assessing the impact and cost-effectiveness of needle and syringe provision and opioid substitution therapy on hepatitis C transmission among people who inject drugs in the UK: an analysis of pooled data sets and economic modelling

et al. 2017

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Background There is limited evidence of the impact of needle and syringe programmes (NSPs) and opioid substitution therapy (OST) on hepatitis C virus (HCV) incidence among people who inject drugs (PWID), nor have there been any economic evaluations. Objective(s) To measure (1) the impact of NSP and OST, (2) changes in the extent of provision of both interventions, and (3) costs and cost-effectiveness of NSPs on HCV infection transmission. Design We conducted (1) a systematic review; (2) an analysis of existing data sets, including collating costs of NSPs; and (3) a dynamic deterministic model to estimate the impact of differing OST/NSP intervention coverage levels for reducing HCV infection prevalence, incidence and disease burden, and incremental cost-effectiveness ratios to measure the cost-effectiveness of current NSP provision versus no provision. Setting Cost-effectiveness analysis and impact modelling in three UK sites. The pooled analysis drew on data from the UK and Australia. The review was international. Participants PWID. Interventions NSP coverage (proportion of injections covered by clean needles) and OST. Outcome New cases of HCV infection. Results The review suggested that OST reduced the risk of HCV infection acquisition by 50% [rate ratio (RR) 0.50, 95% confidence interval (CI) 0.40 to 0.63]. Weaker evidence was found in areas of high (≥ 100%) NSP coverage (RR 0.77, 95% CI 0.38 to 1.54) internationally. There was moderate evidence for combined high coverage of NSPs and OST (RR 0.29, 95% CI 0.13 to 0.65). The pooled analysis showed that combined high coverage of NSPs and OST reduced the risk of HCV infection acquisition by 29–71% compared with those on minimal harm reduction (no OST, ≤ 100% NSP coverage). NSPs are likely to be cost-effective and are cost-saving in some settings. The impact modelling suggest that removing OST (current coverage 81%) and NSPs (coverage 54%) in one site would increase HCV infection incidence by 329% [95% credible interval (CrI) 110% to 953%] in 2031 and at least double (132% increase; 95% CrI 51% to 306%) the number of new infections over 15 years. Increasing NSP coverage to 80% has the largest impact in the site with the lowest current NSP coverage (35%), resulting in a 27% (95% CrI 7% to 43%) decrease in new infections and 41% (95% CrI 11% to 72%) decrease in incidence by 2031 compared with 2016. Addressing homelessness and reducing the harm associated with the injection of crack cocaine could avert approximately 60% of HCV infections over the next 15 years. Limitations Findings are limited by the misclassification of NSP coverage and the simplified intervention definition that fails to capture the integrated services that address other social and health needs as part of this. Conclusions There is moderate evidence of the effectiveness of OST and NSPs, especially in combination, on HCV infection acquisition risk. Policies to ensure that NSPs can be accessed alongside OST are needed. NSPs are cost-saving in some sites and cost-effective in others. NSPs and OST are likely to prevent considerable rates of HCV infection in the UK. Increasing NSP coverage will have most impact in settings with low coverage. Scaling up other interventions such as HCV infection treatment are needed to decrease epidemics to low levels in higher prevalence settings. Future work To understand the mechanisms through which NSPs and OST achieve their effect and the optimum contexts to support implementation. Funding The National Institute for Health Research Public Health Research programme.

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Section: Model Parameterisationmentioning

confidence: 99%

Assessing the impact and cost-effectiveness of needle and syringe provision and opioid substitution therapy on hepatitis C transmission among people who inject drugs in the UK: an analysis of pooled data sets and economic modelling

et al. 2017

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“…1b), as well as with other antiviral molecules in treatment of patients with genotype-1HCV infection [4,5]. LD is a new HCV NS5A inhibitor with an antiviral activity [6]. A fixeddose combination of SF/LD was approved for the treatment of patients infected with genotype 1HCV [7].…”

Section: Introductionmentioning

confidence: 99%

Quantification of sofosbuvir and ledipasvir in human plasma by UPLC–MS/MS method: Application to fasting and fed bioequivalence studies

Rezk

Bendas

Basalious

et al. 2016

Journal of Chromatography B

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“…26 Interferon based treatment regimens are no longer recommended for HCV infection as oral, direct acting antiviral agents are now considered first line therapy. 28 Up to 30% of HCV infected patients receiving interferon therapy develop major depression.…”

Section: Chronic Infectionmentioning

confidence: 99%

Hepatitis C

Ahmad

2017

BMJ

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Treatment of Hepatitis C

Cited by 395 publications

References 54 publications

Assessing the impact and cost-effectiveness of needle and syringe provision and opioid substitution therapy on hepatitis C transmission among people who inject drugs in the UK: an analysis of pooled data sets and economic modelling

Assessing the impact and cost-effectiveness of needle and syringe provision and opioid substitution therapy on hepatitis C transmission among people who inject drugs in the UK: an analysis of pooled data sets and economic modelling

Quantification of sofosbuvir and ledipasvir in human plasma by UPLC–MS/MS method: Application to fasting and fed bioequivalence studies

Hepatitis C

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