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Assessing the Long-Term Impact of Treating Hepatitis C Virus (HCV)-Infected People Who Inject Drugs in the UK and the Relationship between Treatment Uptake and Efficacy on Future Infections.

Bennett H, McEwan P, Sugrue D, Kalsekar A, Yuan Y - PLoS ONE (2015)

Bottom Line: SoC led to modest reductions in prevalence; >5% after 200 years.New treatments achieving 90% SVR could reduce prevalence below 5% within 60 years at current uptake rates or within 5 years if all patients are treated.Increased treatment among PWID with new more efficacious therapies could significantly change the future dynamics, cost and health burden of HCV-related disease.

View Article: PubMed Central - PubMed

Affiliation: Health Economics & Outcomes Research Ltd., Cardiff, Wales, United Kingdom.

ABSTRACT

Objective: The prevalence of the hepatitis C virus (HCV) remains high amongst people who inject drugs (PWID) and accounts for the majority of newly acquired infections. This study aims to quantify the value of treatment amongst PWID with more efficacious treatments and at increased uptake rates, with respect to the avoidance of future infections and subsequent long-term complications of HCV.

Methods: A dynamic HCV transmission and disease progression model was developed, incorporating acute and chronic infection and their long-term complications (decompensated cirrhosis, cancer, liver transplant and mortality), with the potential for HCV transmission to other PWID prior to successful treatment. The model was populated with prevalence and therapy data from a UK setting. Scenarios of current standard of care (SoC) treatment efficacy and uptake were compared to anticipated sustained virologic response (SVR) rates of 90-100% and increased uptake over varied horizons.

Results: SoC led to modest reductions in prevalence; >5% after 200 years. New treatments achieving 90% SVR could reduce prevalence below 5% within 60 years at current uptake rates or within 5 years if all patients are treated. Amongst 4,240 PWID, chronic HCV infections avoided as a result of increasing treatment uptake over the period 2015-2027 ranged from 20-580 and 34-912 with SoC and 90% SVR rates respectively. The reduction in downstream HCV infections due to increasing treatment uptake resulted in an approximate discounted gain of 300 life-years (from avoiding reduced life expectancy from HCV infection) and a gain of 1,700 QALYs (from avoiding the disutility of HCV infection and related complications), with a projected £5.4 million cost saving.

Conclusion: While improved SVR profiles led to reductions in modelled prevalence, increased treatment uptake was the key driver of future infections avoided. Increased treatment among PWID with new more efficacious therapies could significantly change the future dynamics, cost and health burden of HCV-related disease.

No MeSH data available.


Related in: MedlinePlus

Modelled long-term prevalence of chronic HCV among PWIDs with varied treatment uptake.PWID = people who inject drugs.
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pone.0125846.g002: Modelled long-term prevalence of chronic HCV among PWIDs with varied treatment uptake.PWID = people who inject drugs.

Mentions: Martin et al demonstrated that, with current treatment uptake rates, the prevalence of HCV would decline over the next 15 years [2]. However, by projecting the transmission of HCV over a longer time horizon, results from this analysis demonstrated that with the use of current treatments at current uptake rates, the prevalence of chronic HCV would remain in excess of 5% of the total PWID population in 200 years. By contrast, with new treatments estimated to achieve 90% SVR, chronic prevalence would fall below 5% by 2070 and below 1% by 2077 (Fig 2) at the same uptake rate. Over 100 years, the use of such treatments was estimated to prevent more than 5,000 new cases of chronic HCV infection amongst a steady PWID population size of 4,240.


Assessing the Long-Term Impact of Treating Hepatitis C Virus (HCV)-Infected People Who Inject Drugs in the UK and the Relationship between Treatment Uptake and Efficacy on Future Infections.

Bennett H, McEwan P, Sugrue D, Kalsekar A, Yuan Y - PLoS ONE (2015)

Modelled long-term prevalence of chronic HCV among PWIDs with varied treatment uptake.PWID = people who inject drugs.
© Copyright Policy
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4418568&req=5

pone.0125846.g002: Modelled long-term prevalence of chronic HCV among PWIDs with varied treatment uptake.PWID = people who inject drugs.
Mentions: Martin et al demonstrated that, with current treatment uptake rates, the prevalence of HCV would decline over the next 15 years [2]. However, by projecting the transmission of HCV over a longer time horizon, results from this analysis demonstrated that with the use of current treatments at current uptake rates, the prevalence of chronic HCV would remain in excess of 5% of the total PWID population in 200 years. By contrast, with new treatments estimated to achieve 90% SVR, chronic prevalence would fall below 5% by 2070 and below 1% by 2077 (Fig 2) at the same uptake rate. Over 100 years, the use of such treatments was estimated to prevent more than 5,000 new cases of chronic HCV infection amongst a steady PWID population size of 4,240.

Bottom Line: SoC led to modest reductions in prevalence; >5% after 200 years.New treatments achieving 90% SVR could reduce prevalence below 5% within 60 years at current uptake rates or within 5 years if all patients are treated.Increased treatment among PWID with new more efficacious therapies could significantly change the future dynamics, cost and health burden of HCV-related disease.

View Article: PubMed Central - PubMed

Affiliation: Health Economics & Outcomes Research Ltd., Cardiff, Wales, United Kingdom.

ABSTRACT

Objective: The prevalence of the hepatitis C virus (HCV) remains high amongst people who inject drugs (PWID) and accounts for the majority of newly acquired infections. This study aims to quantify the value of treatment amongst PWID with more efficacious treatments and at increased uptake rates, with respect to the avoidance of future infections and subsequent long-term complications of HCV.

Methods: A dynamic HCV transmission and disease progression model was developed, incorporating acute and chronic infection and their long-term complications (decompensated cirrhosis, cancer, liver transplant and mortality), with the potential for HCV transmission to other PWID prior to successful treatment. The model was populated with prevalence and therapy data from a UK setting. Scenarios of current standard of care (SoC) treatment efficacy and uptake were compared to anticipated sustained virologic response (SVR) rates of 90-100% and increased uptake over varied horizons.

Results: SoC led to modest reductions in prevalence; >5% after 200 years. New treatments achieving 90% SVR could reduce prevalence below 5% within 60 years at current uptake rates or within 5 years if all patients are treated. Amongst 4,240 PWID, chronic HCV infections avoided as a result of increasing treatment uptake over the period 2015-2027 ranged from 20-580 and 34-912 with SoC and 90% SVR rates respectively. The reduction in downstream HCV infections due to increasing treatment uptake resulted in an approximate discounted gain of 300 life-years (from avoiding reduced life expectancy from HCV infection) and a gain of 1,700 QALYs (from avoiding the disutility of HCV infection and related complications), with a projected £5.4 million cost saving.

Conclusion: While improved SVR profiles led to reductions in modelled prevalence, increased treatment uptake was the key driver of future infections avoided. Increased treatment among PWID with new more efficacious therapies could significantly change the future dynamics, cost and health burden of HCV-related disease.

No MeSH data available.


Related in: MedlinePlus