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Choi HY, Kim KA, Park BY, Choi BY, Ki M. Economic evaluation of mass screening as a strategy for hepatitis C virus elimination in South Korea. J Infect Public Health 2025; 18:102662. [PMID: 39842191 DOI: 10.1016/j.jiph.2025.102662] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2024] [Revised: 01/05/2025] [Accepted: 01/07/2025] [Indexed: 01/24/2025] Open
Abstract
BACKGROUND This study examines Hepatitis C virus (HCV) screening scenarios to meet World Health Organization (WHO) elimination targets (incidence ≤5 per 100,000, mortality ≤2 per 100,000) and assesses their timeframes and cost-effectiveness. METHODS A closed cohort model of Koreans aged 30-79 in 2020 projected HCV incidence and mortality over 20 years. Economic evaluations used a dynamic transmission model, considering prevalent and annual incident cases. This approach addresses the limitations of previous models that neglected annual new HCV infections. Nine scenarios with varying screening intervals were created considering health checkup uptake, treatment rates, and HCV incidence reduction. Economic evaluations from the healthcare system's perspective employed cost-utility and cost-benefit analyses. RESULTS Without national HCV screening, incidence slightly decreases, whereas mortality triples over 20 years. Introducing HCV screening offers five scenarios to meet WHO targets in 20 years. The quickest, involving biennial screening, high uptake, and a 30% incidence reduction, meets the incidence target at 6 years and mortality target at 14 years. For the most cost-efficient scenario, screening every 4 years with moderate uptake and a 20% incidence reduction meets the incidence target at 17 years and mortality target at 18 years. The Incremental Cost-Effectiveness Ratio (ICER) is $8,867 per quality-adjusted life-year (QALY), with a Benefit-Cost Ratio (BCR) of 1.60. CONCLUSION The absence of HCV screening impedes elimination goals and increases mortality. Biennial screening, with high participation and treatment rates, rapidly achieves targets but is less economically efficient. Screening every 4 years with moderate uptake and treatment rates is economically feasible and meets elimination goals within 20 years. Rapid screening implementation is crucial for effective HCV elimination.
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Affiliation(s)
- Hwa Young Choi
- Department of Cancer Control and Population Health, National Cancer Center Graduate School of Cancer Science and Policy, Goyang, Republic of Korea
| | - Kyung-Ah Kim
- Department of Internal Medicine, Inje University Ilsan Paik Hospital, Goyang, Republic of Korea
| | - Bo Young Park
- Department of Preventive Medicine, Hanyang University College of Medicine, Seoul, Republic of Korea
| | - Bo Youl Choi
- Department of Preventive Medicine, Hanyang University College of Medicine, Seoul, Republic of Korea
| | - Moran Ki
- Department of Cancer Control and Population Health, National Cancer Center Graduate School of Cancer Science and Policy, Goyang, Republic of Korea.
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Wu HJ, Applegate TL, Kwon JA, Cunningham EB, Grebely J, Gray RT, Shih ST. The cost-effectiveness of integrating simplified HCV testing into HIV pre-exposure prophylaxis (PrEP) and treatment services among men who have sex with men in Taiwan. THE LANCET REGIONAL HEALTH. WESTERN PACIFIC 2024; 48:101119. [PMID: 38974907 PMCID: PMC11227020 DOI: 10.1016/j.lanwpc.2024.101119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/05/2024] [Revised: 05/09/2024] [Accepted: 05/29/2024] [Indexed: 07/09/2024]
Abstract
Background Simplified hepatitis C virus (HCV) testing integrated into existing HIV services has the potential to improve HCV diagnoses and treatment. We evaluated the cost-effectiveness of integrating different simplified HCV testing strategies into existing HIV pre-exposure prophylaxis (PrEP) and treatment services among men who have sex with men (MSM) in Taiwan. Methods Mathematical modeling was used to assess the cost-effectiveness of integrating simplified HCV tests (point-of-care antibody, reflex RNA, or immediate point-of-care RNA) with HCV treatment into existing HIV prevention and care for MSM from a healthcare perspective. The impact of increasing PrEP and HIV treatment coverage among MSM in combination with these HCV testing strategies was also considered. We reported lifetime costs (2022 US dollars) and quality-adjusted life years (QALYs) and calculated incremental cost-effectiveness ratios (ICERs) with a 3% annual discounting rate. Findings Point-of-care HCV antibody and reflex RNA testing are cost-effective compared to current HCV testing in all PrEP and HIV treatment coverage scenarios (ICERs <$32,811/QALY gained). Immediate point-of-care RNA testing would be only cost-effective compared to the current HCV testing if coverage of HIV services remained unchanged. Point-of-care antibody testing in an unchanged HIV services coverage scenario and all simplified HCV testing strategies in scenarios that increased both HIV PrEP and treatment coverage form an efficient frontier, indicating best value for money strategies. Interpretation Our findings support the integration of simplified HCV testing and people-centered services for MSM and highlight the economic benefits of integrating simplified HCV testing into existing services for MSM alongside HIV PrEP and treatment. Funding This study was made possible as part of a research-funded PhD being undertaken by HJW under the UNSW Sydney Scientia scholarship and was associated with the Rapid Point of Care Research Consortium for infectious disease in the Asia Pacific (RAPID), which is funded by an NHMRC Centre for Research Excellence. JG is supported by a National Health and Medical Research Council Investigator Grant (1176131).
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Affiliation(s)
- Huei-Jiuan Wu
- The Kirby Institute, University of New South Wales Sydney, Sydney, NSW 2052, Australia
| | - Tanya L. Applegate
- The Kirby Institute, University of New South Wales Sydney, Sydney, NSW 2052, Australia
| | - Jisoo A. Kwon
- The Kirby Institute, University of New South Wales Sydney, Sydney, NSW 2052, Australia
| | - Evan B. Cunningham
- The Kirby Institute, University of New South Wales Sydney, Sydney, NSW 2052, Australia
| | - Jason Grebely
- The Kirby Institute, University of New South Wales Sydney, Sydney, NSW 2052, Australia
| | - Richard T. Gray
- The Kirby Institute, University of New South Wales Sydney, Sydney, NSW 2052, Australia
| | - Sophy T.F. Shih
- The Kirby Institute, University of New South Wales Sydney, Sydney, NSW 2052, Australia
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Shetty A, Lee M, Valenzuela J, Saab S. Cost effectiveness of hepatitis C direct acting agents. Expert Rev Pharmacoecon Outcomes Res 2024; 24:589-597. [PMID: 38665122 DOI: 10.1080/14737167.2024.2348053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Accepted: 04/23/2024] [Indexed: 05/04/2024]
Abstract
INTRODUCTION Introduction of direct acting antivirals (DAA) has transformed treatment of chronic hepatitis C (HCV) and made the elimination of HCV an achievable goal set forward by World Health Organization by 2030. Multiple barriers need to be overcome for successful eradication of HCV. Availability of pan-genotypic HCV regimens has decreased the need for genotype testing but maintained high efficacy associated with DAAs. AREAS COVERED In this review, we will assess the cost-effectiveness of DAA treatment in patients with chronic HCV disease, with emphasis on general, cirrhosis, and vulnerable populations. EXPERT OPINION Multiple barriers exist limiting eradication of HCV, including cost to treatment, access, simplified testing, and implementing policy to foster treatment for all groups of HCV patients. Clinically, DAAs have drastically changed the landscape of HCV, but focused targeting of vulnerable groups is needed. Public policy will continue to play a strong role in eliminating HCV. While we will focus on the cost-effectiveness of DAA, several other factors regarding HCV require on going attention, such as increasing public awareness and decreasing social stigma associated with HCV, offering universal screening followed by linkage to treatment and improving preventive interventions to decrease spread of HCV.
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Affiliation(s)
- Akshay Shetty
- Department of Medicine, University of California at Los Angeles, Los Angeles, CA, USA
- Department of Surgery, University of California at Los Angeles, Los Angeles, CA, USA
| | - Michelle Lee
- Department of Surgery, University of California at Los Angeles, Los Angeles, CA, USA
| | - Julia Valenzuela
- Department of Surgery, University of California at Los Angeles, Los Angeles, CA, USA
| | - Sammy Saab
- Department of Medicine, University of California at Los Angeles, Los Angeles, CA, USA
- Department of Surgery, University of California at Los Angeles, Los Angeles, CA, USA
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Petkevičienė J, Voeller A, Čiupkevičienė E, Razavi-Shearer D, Liakina V, Jančorienė L, Kazėnaitė E, Zaksas V, Urbonas G, Kupčinskas L. Hepatitis C screening in Lithuania: first-year results and scenarios for achieving WHO elimination targets. BMC Public Health 2024; 24:1055. [PMID: 38622549 PMCID: PMC11020450 DOI: 10.1186/s12889-024-18470-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2023] [Accepted: 03/28/2024] [Indexed: 04/17/2024] Open
Abstract
BACKGROUND The World Health Organization (WHO) has outlined a set of targets to achieve eliminating hepatitis C by 2030. In May 2022, Lithuanian health authorities initiated a hepatitis C virus (HCV) screening program to start working towards elimination. In the program, bonus was given to general practitioners (GPs) to promote and conduct anti-HCV tests for two situations: (1) one time testing for individuals born in 1945-1994 and (2) annual HCV testing for persons who inject drugs or are living with human immunodeficiency virus (HIV) regardless of age. This study aimed to model the current viral hepatitis C epidemiological status in Lithuania and to outline the requirements for WHO elimination targets using the first-year HCV screening results. METHODS Individuals were invited to participate in the anti-HCV screening by GPs during routine visits. Patients who tested positive were then referred to a gastroenterologist or infectious disease doctor for further confirmatory testing. If a patient received a positive RNA test and a fibrosis staging result of ≥ F2, the doctor prescribed direct-acting antivirals. Information on the patients screened, diagnosed, and treated was obtained from the National Health Insurance Fund. The Markov disease progression model, developed by the CDA Foundation, was used to evaluate the screening program results and HCV elimination progress in Lithuania. RESULTS Between May 2022 and April 2023, 790,070 individuals underwent anti-HCV testing, with 11,943 individuals (1.5%) receiving positive results. Anti-HCV seroprevalence was found to be higher among males than females, 1.9% and 1.2%, respectively. Within the risk population tested, 2087 (31.1%) seropositive individuals were identified. When comparing the screening program results to WHO elimination targets through modelling, 2180 patients still need to be treated annually until 2030, along with expanding fibrosis restrictions. If an elimination approach was implemented, 1000 new infections would be prevented, while saving 150 lives and averting 90 decompensated cirrhosis cases and 110 hepatocellular carcinoma cases. CONCLUSIONS During the first year of the Lithuanian screening program, GPs were able to screen 44% of the target population. However, the country will not meet elimination targets as it currently stands without increasing treatment levels and lifting fibrosis restrictions.
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Affiliation(s)
- Janina Petkevičienė
- Health Research Institute, Faculty of Public Health, Lithuanian University of Health Sciences, Tilžės str. 18, LT47181, Kaunas, Lithuania.
- Department of Preventive Medicine, Faculty of Public Health, Lithuanian University of Health Sciences, Tilžės str. 18, LT47181, Kaunas, Lithuania.
| | - Alexis Voeller
- Center for Disease Analysis Foundation, 1120 W South Boulder Rd, Suite 102, Lafayette, CO, USA
| | - Eglė Čiupkevičienė
- Health Research Institute, Faculty of Public Health, Lithuanian University of Health Sciences, Tilžės str. 18, LT47181, Kaunas, Lithuania
| | - Devin Razavi-Shearer
- Center for Disease Analysis Foundation, 1120 W South Boulder Rd, Suite 102, Lafayette, CO, USA
| | - Valentina Liakina
- Faculty of Medicine, Vilnius University, Universiteto str. 3, LT01513, Vilnius, Lithuania
- Faculty of Fundamental Sciences, Vilnius Tech, Saulėtekio av. 11, LT10223, Vilnius, Lithuania
| | - Ligita Jančorienė
- Clinic of Infectious Diseases and Dermatovenerology, Institute of Clinical Medicine, Medical Faculty, Vilnius University, Santariškių str. 14, 08406, Vilnius, Lithuania
| | - Edita Kazėnaitė
- Faculty of Medicine, Vilnius University, Universiteto str. 3, LT01513, Vilnius, Lithuania
- Vilnius University Hospital Santaros Klinikos, Santariškių str. 2, LT08661, Vilnius, Lithuania
| | - Viačeslavas Zaksas
- National Health Insurance Fund under the Ministry of Health, Europos Sq. 1, LT03505, Vilnius, Lithuania
| | - Gediminas Urbonas
- Department of Family Medicine, Lithuanian University of Health Sciences, Eivenių str. 2, LT50161, Kaunas, Lithuania
| | - Limas Kupčinskas
- Department of Gastroenterology, Lithuanian University of Health Sciences, Eivenių str. 2, LT50161, Kaunas, Lithuania
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Taha G, Ezra L, Abu-Freha N. Hepatitis C Elimination: Opportunities and Challenges in 2023. Viruses 2023; 15:1413. [PMID: 37515101 PMCID: PMC10386528 DOI: 10.3390/v15071413] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Revised: 06/08/2023] [Accepted: 06/20/2023] [Indexed: 07/30/2023] Open
Abstract
Hepatitis C Virus (HCV) infection is a leading etiology of liver cirrhosis and its associated complications, namely, decompensated cirrhosis. As such, hepatitis C potentially necessitates liver transplantation and may result in death. Recently, HCV treatment has evolved. Current HCV treatment is effective in curing HCV; some of the agents are pan-genotypic. Numerous countries have adopted an initiative to eliminate HCV. Achieving elimination poses many challenges; it requires improved availability and accessibility of pan-genotypic therapy. Barriers exist at the level of the collective healthcare system and at the level of the individual healthcare providers and patients. Therefore, organized national and local efforts are needed. Surmounting these barriers calls for interventions concerning screening, linkage to care, and treatment delivery. Pertinent barriers include inadequate availability of screening, ill-equipped laboratory testing before treatment, and insufficient access to treatment. Interventions should seek to decentralize laboratory testing and treatment provision, increase funding for resources and personnel, and spread awareness. Special consideration should be allocated to at-risk populations, such as intravenous drug users, refugees, and prisoners. Computerized medical filing and telemedicine have the potential to refine HCV management by enhancing detection, availability, accessibility, and cost-effectiveness.
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Affiliation(s)
- Gadeer Taha
- Department of Gastroenterology, Rambam Health Care Campus, Haifa 31096, Israel
| | - Levy Ezra
- Medical School for International Health, Ben-Gurion University of the Negev, Beer-Sheva 84101, Israel
| | - Naim Abu-Freha
- Institute of Gastroenterology and Hepatology, Soroka University Medical Center, Beer-Sheva 84101, Israel
- Faculty of Health Sciences, Ben Gurion University of the Negev, Beer-Sheva 84105, Israel
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Krüger K, Rossol S, Krauth C, Buggisch P, Mauss S, Stoehr A, Klinker H, Böker K, Teuber G, Stahmeyer J. Real-world experience for the outcomes and costs of treating hepatitis C patients: Results from the German Hepatitis C-Registry (DHC-R). ZEITSCHRIFT FUR GASTROENTEROLOGIE 2023; 61:489-503. [PMID: 35839795 PMCID: PMC10162862 DOI: 10.1055/a-1852-5713] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/07/2023]
Abstract
BACKGROUND & AIMS With long-term consequences like the development of liver cirrhosis and hepatocellular carcinoma, chronic hepatitis C virus (HCV) infection is associated with a significant health burden. Information on HCV treatment outcomes and costs in routine care is still rare, especially for subgroups. The aim of this study was to analyse the treatment outcomes and costs of subgroups in routine care and to compare them over time with previous analyses. METHODS Data were derived from a noninterventional study including a subset of 10298 patients receiving DAAs with genotypes 1 and 3. Sociodemographic, clinical parameters and costs were collected using a web-based data recording system. The total sample was subdivided according to treatment regimen, cirrhosis status as well as present HIV infection and opioid substitution treatment (OST). RESULTS 95% of all patients achieved SVR. Currently used DAA showed higher SVR-rates and less adverse events (AE) compared to former treatments. Concerning subgroups, cirrhotic patients, HIV-coinfected patients and OST patients showed lower but still high SVR-rates. In comparison, cirrhotic had considerably longer treatment duration and more frequent (serious) AE. Overall, average treatment costs were €48470 and costs per SVR were €51129; for currently used DAAs costs amounted to €30330 and costs per SVR to €31692. After the end of treatment, physical health is similar to the general population in all patients except cirrhotic. Mental health remains far behind in all subgroups, even for currently used DAA. CONCLUSIONS Over time, some relevant factors developed positively (SVR-rates, costs, treatment duration, adverse events, health-related quality of life (HRQoL)). Further research on HRQoL, especially on mental health, is necessary to evaluate the differences between subgroups and HRQoL over time and to identify influencing factors.
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Affiliation(s)
- Kathrin Krüger
- Institute for Epidemiology, Social Medicine and Health Systems Research, Hannover Medical School, Hannover, Germany
| | - Siegbert Rossol
- Medizinische Klinik, Krankenhaus Nordwest, Frankfurt, Germany
| | - Christian Krauth
- Institute for Epidemiology, Social Medicine and Health Systems Research, Hannover Medical School, Hannover, Germany
| | - Peter Buggisch
- ifi-Institut für interdisziplinäre Medizin, Hamburg, Germany
| | - Stefan Mauss
- Center for HIV and Hepatogastroenterology, Duesseldorf, Germany
| | - Albrecht Stoehr
- ifi-Institut für interdisziplinäre Medizin, Hamburg, Germany
| | | | | | | | - Jona Stahmeyer
- Institute for Epidemiology, Social Medicine and Health Systems Research, Hannover Medical School, Hannover, Germany
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Tan C, Luo X, Ong BS, Lin L, Ng K. Real-world impact of a subsidy decision of sofosbuvir-velpatasvir for treatment of chronic hepatitis C on clinical practice and patient outcomes. JGH Open 2022; 7:48-54. [PMID: 36660045 PMCID: PMC9840192 DOI: 10.1002/jgh3.12850] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Revised: 11/08/2022] [Accepted: 11/18/2022] [Indexed: 12/02/2022]
Abstract
Background and Aim Sofosbuvir-velpatasvir was recommended for subsidy to treat chronic hepatitis C in Singapore in 2018. We measured the impact of the subsidy decision on clinical practice and patient outcomes. Specifically, we looked at pre- and post-subsidy changes in the utilization and prescribing pattern of chronic hepatitis C treatment and the real-world clinical effectiveness. Method Utilization trends and prescribing patterns were assessed using aggregated drug utilization data from public hospitals' dispensing systems and clinical data from the national electronic health record database, respectively. An audit was conducted to evaluate sustained virological response rate 12 weeks post treatment (SVR12). Results Use of sofosbuvir-velpatasvir increased sharply since its subsidy listing and dropped subsequently, whereas the utilization of comparator drugs remained low. Prescribing rate of sofosbuvir-velpatasvir increased from 13.7% in the pre-subsidy period to 90.2% in the post-subsidy period; 39.1% of patients previously on pegylated interferon and ribavirin switched to sofosbuvir-velpatasvir following its subsidy listing. In the audit, 365 out of 375 patients (97.3% [95% confidence interval: 95.1-98.6%]) achieved SVR12. Conclusion The subsidy decision led to increased accessibility to patients and intended changes in clinical practice. Sofosbuvir-velpatasvir was also clinically effective in the real world. These findings augur well for the continued eradication of chronic hepatitis C infection in Singapore.
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Affiliation(s)
- Chee‐Kiat Tan
- Department of Gastroenterology and HepatologySingapore General HospitalSingapore
| | - Xue‐Shi Luo
- Agency for Care Effectiveness, Ministry of HealthSingapore
| | | | - Liang Lin
- Agency for Care Effectiveness, Ministry of HealthSingapore
| | - Kwong‐Hoe Ng
- Agency for Care Effectiveness, Ministry of HealthSingapore
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Schnitzler L, Evers SMAA, Jackson LJ, Paulus ATG, Roberts TE. Are intersectoral costs considered in economic evaluations of interventions relating to sexually transmitted infections (STIs)? A systematic review. BMC Public Health 2022; 22:2180. [PMID: 36434561 PMCID: PMC9701033 DOI: 10.1186/s12889-022-14484-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2022] [Accepted: 10/29/2022] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND/OBJECTIVE Sexually transmitted infections (STIs) not only have an impact on the health sector but also the private resources of those affected, their families and other sectors of society (i.e. labour, education). This study aimed to i) review and identify economic evaluations of interventions relating to STIs, which aimed to include a societal perspective; ii) analyse the intersectoral costs (i.e. costs broader than healthcare) included; iii) categorise these costs by sector; and iv) assess the impact of intersectoral costs on the overall study results. METHODS Seven databases were searched: MEDLINE (PubMed), EMBASE (Ovid), Web of Science, CINAHL, PsycINFO, EconLit and NHS EED. Key search terms included terms for economic evaluation, STIs and specific infections. This review considered trial- and model-based economic evaluations conducted in an OECD member country. Studies were included that assessed intersectoral costs. Intersectoral costs were extracted and categorised by sector using Drummond's cost classification scheme (i.e. patient/family, productivity, costs in other sectors). A narrative synthesis was performed. RESULTS Twenty-nine studies qualified for data extraction and narrative synthesis. Twenty-eight studies applied a societal perspective of which 8 additionally adopted a healthcare or payer perspective, or both. One study used a modified payer perspective. The following sectors were identified: patient/family, informal care, paid labour (productivity), non-paid opportunity costs, education, and consumption. Patient/family costs were captured in 11 studies and included patient time, travel expenses, out-of-pocket costs and premature burial costs. Informal caregiver support (non-family) and unpaid help by family/friends was captured in three studies. Paid labour losses were assessed in all but three studies. Three studies also captured the costs and inability to perform non-paid work. Educational costs and future non-health consumption costs were each captured in one study. The inclusion of intersectoral costs resulted in more favourable cost estimates. CONCLUSIONS This systematic review suggests that economic evaluations of interventions relating to STIs that adopt a societal perspective tend to be limited in scope. There is an urgent need for economic evaluations to be more comprehensive in order to allow policy/decision-makers to make better-informed decisions.
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Affiliation(s)
- Lena Schnitzler
- grid.6572.60000 0004 1936 7486Health Economics Unit, Institute of Applied Health Research, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK ,grid.5012.60000 0001 0481 6099Department of Health Services Research, Care and Public Health Research Institute (CAPHRI), Faculty of Health, Medicine and Life Sciences (FHML), Maastricht University, Maastricht, The Netherlands
| | - Silvia M. A. A. Evers
- grid.5012.60000 0001 0481 6099Department of Health Services Research, Care and Public Health Research Institute (CAPHRI), Faculty of Health, Medicine and Life Sciences (FHML), Maastricht University, Maastricht, The Netherlands ,grid.416017.50000 0001 0835 8259Trimbos Institute, Netherlands Institute of Mental Health and Addiction, Utrecht, The Netherlands
| | - Louise J. Jackson
- grid.6572.60000 0004 1936 7486Health Economics Unit, Institute of Applied Health Research, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - Aggie T. G. Paulus
- grid.5012.60000 0001 0481 6099Department of Health Services Research, Care and Public Health Research Institute (CAPHRI), Faculty of Health, Medicine and Life Sciences (FHML), Maastricht University, Maastricht, The Netherlands ,grid.5012.60000 0001 0481 6099School of Health Professions Education (SHE), Faculty of Health, Medicine and Life Sciences (FHML), Maastricht University, Maastricht, The Netherlands
| | - Tracy E. Roberts
- grid.6572.60000 0004 1936 7486Health Economics Unit, Institute of Applied Health Research, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
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Denk G, Lange C. [Update Hepatitis C]. MMW Fortschr Med 2022; 164:60-64. [PMID: 36198969 DOI: 10.1007/s15006-022-1841-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Affiliation(s)
- Gerald Denk
- Medizinische Klinik und Poliklinik II/ Transplantationszentrum, Klinikum der Universität München-Großhadern, Marchioninistraße 15, 81377, München, Deutschland.
| | - Christian Lange
- Medizinische Klinik und Poliklinik II / Transplantationszentrum, Klinikum der Universität München-Großhadern, München, Deutschland
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Huang DQ, Nguyen MH. Defining Age-Related Thresholds for ALT and the Risk of Confounders. Clin Gastroenterol Hepatol 2022; 20:715-716. [PMID: 33618026 DOI: 10.1016/j.cgh.2021.02.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Accepted: 02/17/2021] [Indexed: 02/07/2023]
Affiliation(s)
- Daniel Q Huang
- Department of Medicine, Yong Loo Lin School of Medicine, Division of Gastroenterology and Hepatology, National University Health System, Singapore
| | - Mindie H Nguyen
- Division of Gastroenterology and Hepatology, Stanford University Medical Center, Department of Epidemiology and Population Health, Stanford University, Palo Alto, California
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Kouroumalis E, Voumvouraki A. Hepatitis C virus: A critical approach to who really needs treatment. World J Hepatol 2022; 14:1-44. [PMID: 35126838 PMCID: PMC8790391 DOI: 10.4254/wjh.v14.i1.1] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Revised: 04/14/2021] [Accepted: 12/31/2021] [Indexed: 02/06/2023] Open
Abstract
Introduction of effective drugs in the treatment of hepatitis C virus (HCV) infection has prompted the World Health Organization to declare a global eradication target by 2030. Propositions have been made to screen the general population and treat all HCV carriers irrespective of the disease status. A year ago the new severe acute respiratory syndrome coronavirus 2 virus appeared causing a worldwide pandemic of coronavirus disease 2019 disease. Huge financial resources were redirected, and the pandemic became the first priority in every country. In this review, we examined the feasibility of the World Health Organization elimination program and the actual natural course of HCV infection. We also identified and analyzed certain comorbidity factors that may aggravate the progress of HCV and some marginalized subpopulations with characteristics favoring HCV dissemination. Alcohol consumption, HIV coinfection and the presence of components of metabolic syndrome including obesity, hyperuricemia and overt diabetes were comorbidities mostly responsible for increased liver-related morbidity and mortality of HCV. We also examined the significance of special subpopulations like people who inject drugs and males having sex with males. Finally, we proposed a different micro-elimination screening and treatment program that can be implemented in all countries irrespective of income. We suggest that screening and treatment of HCV carriers should be limited only in these particular groups.
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Affiliation(s)
- Elias Kouroumalis
- Department of Gastroenterology, University of Crete Medical School, Heraklion 71500, Crete, Greece
| | - Argyro Voumvouraki
- First Department of Internal Medicine, AHEPA University Hospital, Thessaloniki 54621, Greece
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12
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Kim HL, Kim KA, Choi GH, Jang ES, Ki M, Choi HY, Jeong SH. A cost-effectiveness study of universal screening for hepatitis C virus infection in South Korea: A societal perspective. Clin Mol Hepatol 2022; 28:91-104. [PMID: 34736311 PMCID: PMC8755471 DOI: 10.3350/cmh.2021.0236] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2021] [Revised: 10/08/2021] [Accepted: 11/04/2021] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND/AIMS This study aimed to evaluate the cost-effectiveness of hepatitis C virus (HCV) screening compared to no screening in the Korean population from societal and healthcare system perspectives. METHODS A published decision-tree plus Markov model was used to compare the expected costs and quality-adjusted life years (QALY) between one-time universal HCV screening and no screening in the population aged 40-65 years using the National Health Examination (NHE) program. Input parameters were obtained from analyses of the National Health Insurance claims data, Korean HCV cohort data, or from the literature review. The population aged 40-65 years was simulated in a model spanning a lifetime from both the healthcare system and societal perspectives, which included the cost of productivity loss due to HCV-related deaths. The incremental cost-effectiveness ratio (ICER) between universal screening and no screening was estimated. RESULTS The HCV screening strategy had an ICER of $2,666/QALY and $431/QALY from the healthcare system and societal perspectives, respectively. Both ICERs were far less than the willingness-to-pay threshold of $25,000/QALY, showing that universal screening was highly cost-effective compared to no screening. In various sensitivity analyses, the most influential parameters on cost-effectiveness were the antibodies to HCV (anti-HCV) prevalence, screening costs, and treatment acceptance; however, all ICERs were consistently less than the threshold. If the anti-HCV prevalence was over 0.18%, screening could be cost-effective. CONCLUSION One-time universal HCV screening in the Korean population aged 40-65 years using NHE program would be highly cost-effective from both healthcare system and societal perspectives.
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Affiliation(s)
- Hye-Lin Kim
- College of Pharmacy, Sahmyook University, Seoul, Korea
| | - Kyung-Ah Kim
- Department of Internal Medicine, Inje University Ilsan Paik Hospital, Goyang, Korea
| | - Gwang Hyun Choi
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Eun Sun Jang
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Moran Ki
- Department of Cancer Control and Policy, Graduate School of Cancer Science and Policy, National Cancer Center, Goyang, Korea
| | - Hwa Young Choi
- Department of Cancer Control and Policy, Graduate School of Cancer Science and Policy, National Cancer Center, Goyang, Korea
| | - Sook-Hyang Jeong
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
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Schmidbauer C, Schwarz M, Schütz A, Schubert R, Schwanke C, Gutic E, Pirker R, Lang T, Reiberger T, Haltmayer H, Gschwantler M. Directly observed therapy at opioid substitution facilities using sofosbuvir/velpatasvir results in excellent SVR12 rates in PWIDs at high risk for non-adherence to DAA therapy. PLoS One 2021; 16:e0252274. [PMID: 34086708 PMCID: PMC8177501 DOI: 10.1371/journal.pone.0252274] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Accepted: 05/14/2021] [Indexed: 12/30/2022] Open
Abstract
Background & aims We evaluated the effectiveness of sofosbuvir/velpatasvir (SOF/VEL) in difficult-to-treat PWIDs with presumed high risk for non-adherence to antiviral therapy using an innovative concept involving their opioid agonist therapy (OAT) facility. Methods N = 221 patients (m/f: 168/53; median age: 44.7 years (IQR 16.9); HCV-genotype 3: 45.2%; cirrhosis: 33.9%) treated with SOF/VEL were included. PWIDs at high risk for non-adherence to DAA therapy (n = 122) received HCV treatment alongside OAT under the supervision of medical staff ("directly observed therapy", DOT). These patients were compared to patients with presumed excellent drug compliance, who were treated in a "standard setting" (SS) of SOF/VEL prescription at a tertiary care center (n = 99). Results DOT-patients (n = 122/221; 55.2%) were younger than SS-patients (median age: 41.3 vs. 53.0 years), all had psychiatric comorbidities and most had a poor socioeconomic status. 83/122 (68.0%) reported ongoing intravenous drug use. Within the DOT-group, SVR12 was achieved in 99.1% (95% CI: 95.0–100; n = 109/110) with one patient experiencing treatment failure, while n = 12/122 (9.8%) patients were excluded due to loss of follow-up (FU). 5 patients showed HCV reinfection after achieving SVR12. SS-patients achieved SVR in 96.6% (95% CI: 90.3–99.3%; n = 84/87) after exclusion of 10/99 (10.1%) patients who were lost to FU and 2 patients who died prior to SVR12 due to reasons not related to DAA therapy. Conclusions SOF/VEL given as DOT along with OAT in PWIDs at high risk of non-adherence to antiviral therapy including those with ongoing intravenous drug use resulted in excellent SVR rates similar to patients with presumed “excellent compliance” under standard drug intake.
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Affiliation(s)
- Caroline Schmidbauer
- Department of Internal Medicine IV, Klinik Ottakring, Vienna, Austria
- Division of Gastroenterology and Hepatology, Department of Internal Medicine III, Medical University of Vienna, Vienna, Austria
- Vienna HIV & Liver Study Group, Vienna, Austria
| | - Michael Schwarz
- Department of Internal Medicine IV, Klinik Ottakring, Vienna, Austria
- Division of Gastroenterology and Hepatology, Department of Internal Medicine III, Medical University of Vienna, Vienna, Austria
- Vienna HIV & Liver Study Group, Vienna, Austria
| | - Angelika Schütz
- Ambulatorium Suchthilfe Wien, Suchthilfe Wien gGmbH, Vienna, Austria
| | - Raphael Schubert
- Ambulatorium Suchthilfe Wien, Suchthilfe Wien gGmbH, Vienna, Austria
| | - Cornelia Schwanke
- Ambulatorium Suchthilfe Wien, Suchthilfe Wien gGmbH, Vienna, Austria
| | - Enisa Gutic
- Department of Internal Medicine IV, Klinik Ottakring, Vienna, Austria
| | - Roxana Pirker
- Department of Internal Medicine IV, Klinik Ottakring, Vienna, Austria
| | - Tobias Lang
- Department of Internal Medicine IV, Klinik Ottakring, Vienna, Austria
| | - Thomas Reiberger
- Division of Gastroenterology and Hepatology, Department of Internal Medicine III, Medical University of Vienna, Vienna, Austria
- Vienna HIV & Liver Study Group, Vienna, Austria
| | - Hans Haltmayer
- Ambulatorium Suchthilfe Wien, Suchthilfe Wien gGmbH, Vienna, Austria
| | - Michael Gschwantler
- Department of Internal Medicine IV, Klinik Ottakring, Vienna, Austria
- Sigmund Freud University, Vienna, Austria
- * E-mail:
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Sarrazin C, Boesecke C, Golsabahi‐Broclawski S, Moog G, Negro F, Silaidos C, Patel P, Lohmann K, Spinner CD, Walcher S, Wedemeyer H, Wörns M. Hepatitis C virus: Current steps toward elimination in Germany and barriers to reaching the 2030 goal. Health Sci Rep 2021; 4:e290. [PMID: 34136654 PMCID: PMC8177898 DOI: 10.1002/hsr2.290] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2020] [Revised: 02/24/2021] [Accepted: 04/13/2021] [Indexed: 11/25/2022] Open
Abstract
Hepatitis C virus (HCV) affects over 70 million people globally, with an estimated 399 000 HCV-related deaths in 2016. The World Health Organization (WHO) has set a goal to eliminate HCV by 2030. Despite the availability of direct-acting antivirals-highly effective and well-tolerated therapies for HCV-many patients infected with HCV in Germany have not initiated treatment, including a majority of those who are aware of their positive diagnosis. Barriers to screening, diagnosis, and treatment are major factors taking many countries off track for HCV elimination by 2030. Identifying country-specific barriers and challenges, particularly in at-risk populations such as people who inject drugs or men who have sex with men, has the potential to create tailored programs and strategies to increase access to screening or treatment and engage at-risk populations. This review aims to report the current steps toward HCV elimination in Germany, the country-specific barriers and challenges that will potentially prevent reaching the 2030 HCV elimination goal and describe good practice examples to overcome these barriers.
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Affiliation(s)
- Christoph Sarrazin
- Department of Internal Medicine and Liver CenterSt. Josefs‐Hospital Wiesbaden and Viral Hepatitis Research Group, Goethe‐University Hospital FrankfurtFrankfurtGermany
| | - Christoph Boesecke
- Department of Medicine IUniversity Hospital BonnBonnGermany
- German Centre for Infection Research (DZIF)Partner‐site Bonn‐CologneBonnGermany
| | | | - Gero Moog
- Gastroenterologische Praxis im MarienkrankenhausKasselGermany
| | - Francesco Negro
- Divisions of Gastroenterology and Hepatology and of Clinical PathologyGeneva University HospitalsGenevaSwitzerland
| | | | | | | | - Christoph D. Spinner
- Department of Internal Medicine II, School of Medicine, University Hospital Rechts der IsarTechnical University of MunichMunichGermany
- German Centre for Infection Research (DZIF), Partner Site MunichMunichGermany
| | | | - Heiner Wedemeyer
- Department of GastroenterologyHepatology and Endocrinology, Hannover Medical SchoolHannoverGermany
- Leberstiftungs‐GmbH DeutschlandHannoverGermany
| | - Marcus‐Alexander Wörns
- First Department of MedicineUniversity Medical Centre of the Johannes Gutenberg‐UniversityMainzGermany
- Cirrhosis Centre Mainz (CCM)University Medical Centre of the Johannes Gutenberg‐UniversityMainzGermany
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Macgregor L, Ward Z, Martin NK, Nicholls J, Desai M, Hickson F, Weatherburn P, Hickman M, Vickerman P. The cost-effectiveness of case-finding strategies for achieving hepatitis C elimination among men who have sex with men in the UK. J Viral Hepat 2021; 28:897-908. [PMID: 33759257 PMCID: PMC9132016 DOI: 10.1111/jvh.13503] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Accepted: 03/03/2021] [Indexed: 01/20/2023]
Abstract
Modelling suggests hepatitis C virus (HCV) elimination is possible among men who have sex with men (MSM), with key screening groups including HIV-diagnosed MSM and MSM using pre-exposure prophylaxis (PrEP). Mathematical modelling was used to determine the cost-effectiveness of HCV case-finding strategies among MSM from the provider perspective, and to determine which interventions could achieve a 90% reduction in HCV incidence over 2015-2030. At baseline, we assumed symptomatic screening in HIV-negative MSM (including PrEP users) and 12-monthly screening among HIV-diagnosed MSM. Improved case-finding strategies included screening alongside HIV testing in HIV-negative MSM not using PrEP (PrEP non-users); 12/6/3-monthly screening in PrEP users; and 6-monthly screening in HIV-diagnosed MSM, with the cost-effectiveness being compared incrementally. Costs (GBP) and quality-adjusted life years (QALYs) were assessed to estimate the mean incremental cost-effectiveness ratio (ICER) with a time horizon to 2050, compared to a willingness-to-pay threshold of £20,000/QALY. From the baseline, the most incrementally cost-effective strategy is to firstly undertake: (1) 12-monthly HCV screening of PrEP users (gaining 6715 QALYs with ICER £1760/QALY), followed by (2) HCV screening among PrEP non-users alongside HIV testing (gaining 7048 QALYs with ICER £4972/QALY). Compared to the baseline, this combined strategy would cost £46.9 (95%CrI £25.3-£66.9) million and achieve the HCV elimination target in 100% of model runs. Additional screening incurs ICERs >£20,000/QALY compared to this combined strategy. In conclusion, HCV elimination can be achieved cost-effectively among UK MSM. Policymakers should consider scaling-up HCV screening in HIV-negative MSM, especially PrEP users, for achieving this target.
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Affiliation(s)
- Louis Macgregor
- Population Health Sciences, University of Bristol, Bristol, UK
- National Institute for Health Research Health Protection Research Unit (NIHR HPRU) in Behavioural Science and Evaluation, Bristol, UK
| | - Zoe Ward
- Population Health Sciences, University of Bristol, Bristol, UK
- National Institute for Health Research Health Protection Research Unit (NIHR HPRU) in Behavioural Science and Evaluation, Bristol, UK
| | - Natasha K Martin
- Population Health Sciences, University of Bristol, Bristol, UK
- Division of Infectious Diseases and Global Public Health, University of California, San Diego, CA, USA
| | - Jane Nicholls
- Population Health Sciences, University of Bristol, Bristol, UK
- National Institute for Health Research Health Protection Research Unit (NIHR HPRU) in Behavioural Science and Evaluation, Bristol, UK
- Department of Sexual Health, Cardiff, Vale University Health Board, Cardiff, UK
| | - Monica Desai
- National Institute for Health and Care Excellence, London, UK
| | - Ford Hickson
- Sigma Research, Faculty of Public Health & Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - Peter Weatherburn
- Sigma Research, Faculty of Public Health & Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - Matthew Hickman
- Population Health Sciences, University of Bristol, Bristol, UK
| | - Peter Vickerman
- Population Health Sciences, University of Bristol, Bristol, UK
- National Institute for Health Research Health Protection Research Unit (NIHR HPRU) in Behavioural Science and Evaluation, Bristol, UK
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Kochneva GV, Kartashov MY, Krivosheina EI, Kuznetsov AI, Chub EV, Sivolobova GF, Netesov SV. On the Possibility of Eradicating Hepatitis C in Russia. MOLECULAR GENETICS, MICROBIOLOGY AND VIROLOGY 2021; 36:27-38. [DOI: 10.3103/s0891416821010043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Revised: 10/05/2020] [Accepted: 10/11/2020] [Indexed: 01/05/2025]
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