Prioritization of HCV treatment in the direct-acting antiviral era: An economic evaluation

详细信息    查看全文

• 作者：Natasha K. Martin¹ ; ² ; ^{Natasha-martin@ucsd.edu" class="auth_mail" title="E-mail the corresponding author} ; Peter Vickerman² ; Gregory J. Dore³ ; Jason Grebely³ ; Alec Miners⁴ ; John Cairns⁴ ; Graham R. Foster⁵ ; Sharon J. Hutchinson⁶ ; ⁷ ; David J. Goldberg⁶ ; ⁷ ; Thomas C.S. Martin⁸ ; Mary Ramsay⁹ ; the STOP-HCV Consortium
• 关键词：HCV ; hepatitis C virus ; PWID ; people who inject drugs ; PegIFN ; pegylated interferon ; RBV ; ribavirin ; IFN-free ; interferon-free ; DAA ; direct-acting antiviral ; HCC ; hepatocellular carcinoma ; QALY ; quality adjusted life-year ; NMB ; net monetary benefit ; ESLD ; end stage liver disease ; WTP ; willingness to pay
• 刊名：Journal of Hepatology
• 出版年：2016
• 出版时间：July 2016
• 年：2016
• 卷：65
• 期：1
• 页码：17-25
• 全文大小：796 K

文摘

We determined the optimal HCV treatment prioritization strategy for interferon-free (IFN-free) HCV direct-acting antivirals (DAAs) by disease stage and risk status incorporating treatment of people who inject drugs (PWID).

Methods

A dynamic HCV transmission and progression model compared the cost-effectiveness of treating patients early vs. delaying until cirrhosis for patients with mild or moderate fibrosis, where PWID chronic HCV prevalence was 20, 40 or 60%. Treatment duration was 12 weeks at £3300/wk, to achieve a 95% sustained viral response and was varied by genotype/stage in alternative scenarios. We estimated long-term health costs (in £UK = €1.3 = $1.5) and outcomes as quality adjusted life-years (QALYs) gained using a £20,000 willingness to pay per QALY threshold. We ranked strategies with net monetary benefit (NMB); negative NMB implies delay treatment.

Results

The most cost-effective group to treat were PWID with moderate fibrosis (mean NMB per early treatment £60,640/£23,968 at 20/40% chronic prevalence, respectively), followed by PWID with mild fibrosis (NMB £59,258 and £19,421, respectively) then ex-PWID/non-PWID with moderate fibrosis (NMB £9,404). Treatment of ex-PWID/non-PWID with mild fibrosis could be delayed (NMB -£3,650). In populations with 60% chronic HCV among PWID it was only cost-effective to prioritize DAAs to ex-PWID/non-PWID with moderate fibrosis. For every one PWID in the 20% chronic HCV setting, 2 new HCV infections were averted. One extra HCV-related death was averted per 13 people with moderate disease treated. Rankings were unchanged with reduced drug costs or varied sustained virological response/duration by genotype/fibrosis stage.

Conclusions

Treating PWID with moderate or mild HCV with IFN-free DAAs is cost-effective compared to delay until cirrhosis, except when chronic HCV prevalence and reinfection risk is very high.