Skip to main content

Advertisement

Log in

Hepatitis C disease transmission and treatment uptake: impact on the cost-effectiveness of new direct-acting antiviral therapies

  • Original Paper
  • Published:
The European Journal of Health Economics Aims and scope Submit manuscript

Abstract

Background

Hepatitis C virus (HCV) treatment can reduce the incidence of future infections through removing opportunities for onward transmission. This benefit is not captured in conventional cost-effectiveness evaluations of treatment and is particularly relevant in patient groups with a high risk of transmission, such as those people who inject drugs (PWID), where the treatment rates have been historically low. This study aimed to quantify how reduced HCV transmission changes the cost-effectiveness of new direct-acting antiviral (DAA) regimens as a function of treatment uptake rates.

Methods

An established model of HCV disease transmission and progression was used to quantify the impact of treatment uptake (10–100%), within the PWID population, on the cost-effectiveness of a DAA regimen versus pre-DAA standard of care, conducted using daclatasvir plus sofosbuvir in the UK setting as an illustrative example.

Results

The consequences of reduced disease transmission due to treatment were associated with additional net monetary benefit of £24,304–£90,559 per patient treated at £20,000/QALY, when 10–100% of eligible patients receive treatment with 100% efficacy. Dependent on patient genotype, the cost-effectiveness of HCV treatment using daclatasvir plus sofosbuvir improved by 36–79% versus conventional analysis, at 10–100% treatment uptake in the PWID population.

Conclusions

The estimated cost-effectiveness of HCV treatment was shown to improve as more patients are treated, suggesting that the value of DAA regimens to the NHS could be enhanced by improved treatment uptake rates among PWID. However, the challenge for the future will lie in achieving increased rates of treatment uptake, particularly in the PWID population.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

  1. Shepard, C.W., Finelli, L., Alter, M.J.: Global epidemiology of hepatitis C virus infection. Lancet Infect. Dis. 5(9), 558–567 (2005)

    Article  PubMed  Google Scholar 

  2. Hatzakis, A., Chulanov, V., Gadano, A.C., et al.: The present and future disease burden of hepatitis C virus (HCV) infections with today’s treatment paradigm—volume 2. J. Viral Hepat. 22(Suppl 1), 26–45 (2015)

    Article  PubMed  Google Scholar 

  3. Public Health England, Health Protection Scotland, Public Health Wales, Public Health Agency: Hepatitis C in the UK: 2014 report. https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/337115/HCV_in_the_UK_2014_24_July.pdf (2014). Accessed Jan 2015

  4. Public Health England, Health Protection Scotland, Public Health Wales, Public Health Agency: Shooting up: infections among people who inject drugs in the United Kingdom 2013. https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/370707/Shooting_Up_2014.pdf (2014). Accessed Jan 2015

  5. Afdhal, N.H.: Hepatitis C viral infection in difficult-to-treat populations: an overview. Clin. Liver Dis. 1(3), 63–64 (2012)

    Article  Google Scholar 

  6. Kemmer, N., Neff, G.W.: Managing chronic hepatitis C in the difficult-to-treat patient. Liver Int. 27(10), 1297–1310 (2007)

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  7. European Association for the Study of the Liver: EASL clinical practice guidelines: management of hepatitis C virus infection. J. Hepatol. 60(2), 392–420 (2014)

    Article  Google Scholar 

  8. Sulkowski, M.S., Gardiner, D.F., Rodriguez-Torres, M., et al.: Daclatasvir plus sofosbuvir for previously treated or untreated chronic HCV infection. N. Engl. J. Med. 370(3), 211–221 (2014)

    Article  CAS  PubMed  Google Scholar 

  9. Lawitz, E., Mangia, A., Wyles, D., et al.: Sofosbuvir for previously untreated chronic hepatitis C infection. N. Engl. J. Med. 368(20), 1878–1887 (2013)

    Article  CAS  PubMed  Google Scholar 

  10. Gilead Sciences International Ltd: Summary of product characteristics. Sovaldi® 400 mg film-coated tablets. Updated June 2014. http://www.medicines.org.uk/emc/medicine/28539/SPC/Sovaldi+400+mg+film+coated+tablets/ (2014). Accessed Feb 2015

  11. Janssen-Cilag Ltd: Summary of product characteristics. OLYSIO® 150 mg hard capsules. https://www.medicines.org.uk/emc/medicine/28888 (2014). Accessed Feb 2015

  12. Scottish Medicines Consortium: Daclatasvir 30 and 60 mg film-coated tablets (Daklinza®). SMC No. 1002/14. https://www.scottishmedicines.org.uk/SMC_Advice/Advice/1002_14_daclatasvir_Daklinza/daclatasvir_Daklinza (2014). Accessed Jan 2015

  13. Hagan, L.M., Sulkowski, M.S., Schinazi, R.F.: Cost analysis of sofosbuvir/ribavirin versus sofosbuvir/simeprevir for genotype 1 hepatitis C virus in interferon-ineligible/intolerant individuals. Hepatology 60(1), 37–45 (2014)

    Article  PubMed  PubMed Central  Google Scholar 

  14. Petta, S., Cabibbo, G., Enea, M., et al.: Cost-effectiveness of sofosbuvir-based triple therapy for untreated patients with genotype 1 chronic hepatitis C. Hepatology 59(5), 1692–1705 (2014)

    Article  PubMed  Google Scholar 

  15. Gordon, S.C., Pockros, P.J., Terrault, N.A., et al.: Impact of disease severity on healthcare costs in patients with chronic hepatitis C (CHC) virus infection. Hepatology 56(5), 1651–1660 (2012)

    Article  PubMed  Google Scholar 

  16. Westbrook, R.H., Dusheiko, G.: Natural history of hepatitis C. J. Hepatol. 61(1), S58–S68 (2014)

    Article  PubMed  Google Scholar 

  17. National Institute for Health and Care Excellence: NICE technology appraisal guidance [TA331]. Simeprevir in combination with peginterferon alfa and ribavirin for treating genotypes 1 and 4 chronic hepatitis C. https://www.nice.org.uk/guidance/ta331 (2015). Accessed 16 Mar 2016

  18. National Institute for Health and Care Excellence: NICE technology appraisal guidance [TA364]. Daclatasvir for treating chronic hepatitis C. https://www.nice.org.uk/guidance/ta364 (2015). Accessed 16 Mar 2016

  19. National Institute for Health and Care Excellence: NICE technology appraisal guidance [TA330]. Sofosbuvir for treating chronic hepatitis C. https://www.nice.org.uk/guidance/ta330 (2015). Accessed 16 Mar 2016

  20. National Institute for Health and Care Excellence: NICE technology appraisal guidance [TA363]. Ledipasvir–sofosbuvir for treating chronic hepatitis C. https://www.nice.org.uk/guidance/ta363 (2015). Accessed 16 Mar 2016

  21. National Institute for Health and Care Excellence: NICE technology appraisal guidance [TA365]. Ombitasvir–paritaprevir–ritonavir with or without dasabuvir for treating chronic hepatitis C. https://www.nice.org.uk/guidance/ta365 (2015). Accessed 16 Mar 2016

  22. National Institute for Health and Care Excellence: Single technology appraisal. Daclatasvir for treating chronic hepatitis C: final scope. http://www.nice.org.uk/guidance/gid-tag487/documents/hepatitis-c-chronic-daclatasvir-final-scope2 (2014). Accessed Feb 2015

  23. National Institute for Health and Care Excellence: Single technology appraisal. Ledipasvir–sofosbuvir for treating chronic hepatitis C: final scope. http://www.nice.org.uk/guidance/gid-tag484/documents/hepatitis-c-chronic-ledipasvirsofosbuvir-final-scope2 (2014). Accessed Feb 2015

  24. World Health Organization: Guidelines for the screening, care and treatment of persons with hepatitis C infection. http://www.who.int/hiv/pub/hepatitis/hepatitis-c-guidelines/en/ (2014). Accessed Jan 2015

  25. Martin, N.K., Vickerman, P., Foster, G.R., Hutchinson, S.J., Goldberg, D.J., Hickman, M.: Can antiviral therapy for hepatitis C reduce the prevalence of HCV among injecting drug user populations? A modeling analysis of its prevention utility. J. Hepatol. 54(6), 1137–1144 (2011)

    Article  CAS  PubMed  Google Scholar 

  26. Harris, R.J., Thomas, B., Griffiths, J., et al.: Increased uptake and new therapies are needed to avert rising hepatitis C-related end stage liver disease in England: modelling the predicted impact of treatment under different scenarios. J. Hepatol. 61(3), 530–537 (2014)

    Article  PubMed  Google Scholar 

  27. Martin, N.K., Foster, G.R., Vilar, J., et al.: HCV treatment rates and sustained viral response among people who inject drugs in seven UK sites: real world results and modelling of treatment impact. J. Viral Hepat. 22(4), 399–408 (2015)

    Article  CAS  PubMed  Google Scholar 

  28. Cousien, A., Tran, V.C., Deuffic-Burban, S., Jauffret-Roustide, M., Dhersin, J.S., Yazdanpanah, Y.: Dynamic modelling of hepatitis C virus transmission among people who inject drugs: a methodological review. J. Viral Hepat. 22(3), 213–229 (2015)

    Article  CAS  PubMed  Google Scholar 

  29. Martin, N.K., Vickerman, P., Grebely, J., et al.: Hepatitis C virus treatment for prevention among people who inject drugs: modeling treatment scale-up in the age of direct-acting antivirals. Hepatology 58(5), 1598–1609 (2013)

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  30. Hellard, M.E., Jenkinson, R., Higgs, P., et al.: Modelling antiviral treatment to prevent hepatitis C infection among people who inject drugs in Victoria, Australia. Med. J. Aust. 196(10), 638–641 (2012)

    Article  PubMed  Google Scholar 

  31. Duberg, A.S., Blach, S., Falconer, K., Kaberg, M., Razavi, H., Aleman, S.: The future disease burden of hepatitis C virus infection in Sweden and the impact of different treatment strategies. Scand. J. Gastroenterol. 50(2), 233–244 (2015)

    Article  CAS  PubMed  Google Scholar 

  32. Martin, N.K., Vickerman, P., Dore, G.J., et al.: Prioiritization of HCV treatment in the direct-acting antiviral era: an economic evaluation. J. Hepatol. 65(1), 17–25 (2016)

  33. Bennett, H., McEwan, P., Sugrue, D., Kalsekar, A., Yuan, Y.: 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. PLoS One 10(5), e0125846 (2015)

    Article  PubMed  PubMed Central  Google Scholar 

  34. McEwan, P., Kim, R., Yuan, Y.: Assessing the cost utility of response-guided therapy in patients with chronic hepatitis C genotype 1 in the UK using the MONARCH model. Appl. Health Econ. Health Policy 11(1), 53–63 (2013)

    Article  PubMed  Google Scholar 

  35. McEwan, P., Ward, T., Chen, C.-J., et al.: Estimating the incidence and prevalence of chronic hepatitis C infection in Taiwan using back projection. Value Health Reg. Issues 3, 5–11 (2014)

    Article  Google Scholar 

  36. McEwan, P., Ward, T., Yuan, Y., Kim, R., L’Italien, G.: The impact of timing and prioritization on the cost-effectiveness of birth cohort testing and treatment for hepatitis C virus in the United States. Hepatology 58(1), 54–64 (2013)

    Article  PubMed  Google Scholar 

  37. McEwan, P., Ward, T., Bennett, H., et al.: Estimating the clinical and economic benefit associated with incremental improvements in sustained virologic response in chronic hepatitis C. PLoS One 10(1), e0117334 (2015)

    Article  PubMed  PubMed Central  Google Scholar 

  38. Thein, H.H., Yi, Q., Dore, G.J., Krahn, M.D.: Estimation of stage-specific fibrosis progression rates in chronic hepatitis C virus infection: a meta-analysis and meta-regression. Hepatology 48(2), 418–431 (2008)

    Article  PubMed  Google Scholar 

  39. Kanwal, F., Kramer, J.R., Ilyas, J., Duan, Z., El-Serag, H.B.: HCV genotype 3 is associated with an increased risk of cirrhosis and hepatocellular cancer in a national sample of US Veterans with HCV. Hepatology 60(1), 98–105 (2014)

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  40. Townsend, R., McEwan, P., Kim, R., Yuan, Y.: Structural frameworks and key model parameters in cost-effectiveness analyses for current and future treatments of chronic hepatitis C. Value Health 14(8), 1068–1077 (2011)

    Article  PubMed  Google Scholar 

  41. Shepherd, J., Jones, J., Hartwell, D., Davidson, P., Price, A., Waugh, N.: Interferon alpha (pegylated and non-pegylated) and ribavirin for the treatment of mild chronic hepatitis C: a systematic review and economic evaluation. Health Technol. Assess. 11(11), 1–205 (2007)

    Article  CAS  PubMed  Google Scholar 

  42. Pearlman, B.L., Traub, N.: Sustained virologic response to antiviral therapy for chronic hepatitis C virus infection: a cure and so much more. Clin. Infect. Dis. 52(7), 889–900 (2011)

    Article  PubMed  Google Scholar 

  43. Akhtar, E., Manne, V., Saab, S.: Cirrhosis regression in hepatitis C patients with sustained virological response after antiviral therapy: a meta-analysis. Liver. Int. 35(1), 30–36 (2014)

  44. Im, G.Y., Dieterich, D.T.: Direct-acting antiviral agents in patients with hepatitis C cirrhosis. Gastroenterol. Hepatol. (N. Y.) 8(11), 727–765 (2012)

    Google Scholar 

  45. Personal Social Services Research Unit: Unit costs of Health and Social Care 2013.  http://www.pssru.ac.uk/project-pages/unit-costs/2013/ (2013). Accessed Oct 2015

  46. Public Health England: Commissioning template for estimating HCV prevalence by DAT and numbers eligible for treatment. http://www.hpa.org.uk/Topics/InfectiousDiseases/InfectionsAZ/HepatitisC/EpidemiologicalData/ (2014). Accessed Feb 2015

  47. Public Health England, Health Protection Scotland, Public Health Wales, Public Health Agency: Hepatitis C in the UK: 2013 report. http://www.hpa.org.uk/Publications/InfectiousDiseases/BloodBorneInfections/HepatitisCInTheUK/1307HepatitisCintheUK2013report/ (2013). Accessed Feb 2015

  48. National Institute for Health and Care Excellence: Guide to the methods of technology appraisal 2013. http://www.nice.org.uk/article/pmg9 (2013). Accessed Feb 2015

  49. Leidner, A.J., Chesson, H.W., Xu, F., Ward, J.W., Spradling, P.R., Holmberg, S.D.: Cost-effectiveness of hepatitis C treatment for patients in early stages of liver disease. Hepatology 61(6), 1860–1869 (2015)

    Article  PubMed  Google Scholar 

  50. Leleu, H., Blachier, M., Rosa, I.: Cost-effectiveness of sofosbuvir in the treatment of patients with hepatitis C. J. Viral Hepat. 22(4), 376–383 (2015)

    Article  CAS  PubMed  Google Scholar 

  51. The All-Party Parliamentary Hepatology Group: In the dark: an audit of hospital hepatitis C services across England. http://www.appghep.org.uk/wp-content/uploads/2014/02/In-The-Dark-An-audit-of-hospital-hepatitis-C-services-across-England-APPHG-2010.pdf (2010). Accessed Feb 2015

  52. Arain, A., Robaeys, G.: Eligibility of persons who inject drugs for treatment of hepatitis C virus infection. World J. Gastroenterol. 20(36), 12722–12733 (2014)

    Article  PubMed  PubMed Central  Google Scholar 

  53. Innes, H., Goldberg, D., Dillon, J., Hutchinson, S.J.: Strategies for the treatment of hepatitis C in an era of interferon-free therapies: what public health outcomes do we value most? Gut. 64(11), 1800–1809 (2014)

  54. Hope, V.D., Hickman, M., Ngui, S.L., et al.: Measuring the incidence, prevalence and genetic relatedness of hepatitis C infections among a community recruited sample of injecting drug users, using dried blood spots. J Viral Hepat. 18(4), 262–270 (2011)

    Article  CAS  PubMed  Google Scholar 

  55. Sweeting, M.J., Hope, V.D., Hickman, M., et al.: Hepatitis C infection among injecting drug users in England and Wales (1992–2006): there and back again? Am. J. Epidemiol. 170(3), 352–360 (2009)

    Article  PubMed  PubMed Central  Google Scholar 

  56. Kimber, J., Copeland, L., Hickman, M., et al.: Survival and cessation in injecting drug users: prospective observational study of outcomes and effect of opiate substitution treatment. BMJ 341, c3172 (2010)

    Article  PubMed  PubMed Central  Google Scholar 

  57. Hickman, M., Hope, V., Coleman, B., et al.: Assessing IDU prevalence and health consequences (HCV, overdose and drug-related mortality) in a primary care trust: implications for public health action. J. Public Health (Oxf.) 31(3), 374–382 (2009)

    Article  Google Scholar 

  58. Cornish, R., Macleod, J., Strang, J., Vickerman, P., Hickman, M.: Risk of death during and after opiate substitution treatment in primary care: prospective observational study in UK General Practice Research Database. BMJ 341, c5475 (2010)

    Article  PubMed  PubMed Central  Google Scholar 

  59. Health Protection Scotland and University of the West of Scotland: Needle Exchange Surveillance Initiative (NESI): Prevalence of HCV, HIV and injecting risk behaviours among injecting drug users attending needle exchanges in Scotland, 2007. http://www.hps.scot.nhs.uk/search/atozdetail.aspx?source=8&subject=93 (2008). Accessed Feb 2015

  60. Allen, E.J., Palmateer, N.E., Hutchinson, S.J., Cameron, S., Goldberg, D.J., Taylor, A.: Association between harm reduction intervention uptake and recent hepatitis C infection among people who inject drugs attending sites that provide sterile injecting equipment in Scotland. Int. J. Drug Policy 23(5), 346–352 (2012)

    Article  PubMed  Google Scholar 

  61. University of the West of Scotland: The Needle Exchange Surveillance Initiative (NESI): Prevalence of HCV and injecting risk behaviours among people who inject drugs attending injecting provision services in Scotland, 2008/2009 and 2010. http://www.documents.hps.scot.nhs.uk/bbvsti/hepatitis-c/publications/nesi-needle-exchange.pdf (2011). Accessed Feb 2015

  62. Vickerman, P., Martin, N., Turner, K., Hickman, M.: Can needle and syringe programmes and opiate substitution therapy achieve substantial reductions in hepatitis C virus prevalence? Model projections for different epidemic settings. Addiction 107(11), 1984–1995 (2012)

    Article  PubMed  Google Scholar 

  63. Kemp, P.A., Neale, J., Robertson, M.: Homelessness among problem drug users: prevalence, risk factors and trigger events. Health Soc. Care Community 14(4), 319–328 (2006)

    Article  PubMed  Google Scholar 

  64. Innes, H.A., Hutchinson, S.J., Allen, S., et al.: Ranking predictors of a sustained viral response for patients with chronic hepatitis C treated with pegylated interferon and ribavirin in Scotland. Eur. J. Gastroenterol. Hepatol. 24(6), 646–655 (2012)

    Article  CAS  PubMed  Google Scholar 

  65. Micallef, J.M., Kaldor, J.M., Dore, G.J.: Spontaneous viral clearance following acute hepatitis C infection: a systematic review of longitudinal studies. J. Viral Hepat. 13(1), 34–41 (2006)

    Article  CAS  PubMed  Google Scholar 

  66. Mondelli, M.U., Cerino, A., Cividini, A.: Acute hepatitis C: diagnosis and management. J. Hepatol. 42(1), S108–S114 (2005)

    Article  PubMed  Google Scholar 

  67. Turner, K.M.E., Hutchinson, S., Vickerman, P., et al.: The impact of needle and syringe provision and opiate substitution therapy on the incidence of hepatitis C virus in injecting drug users: pooling of UK evidence. Addiction 106(11), 1978–1988 (2011)

    Article  PubMed  Google Scholar 

  68. Aspinall, E.J., Corson, S., Doyle, J.S., et al.: Treatment of hepatitis C virus infection among people who are actively injecting drugs: a systematic review and meta-analysis. Clin. Infect. Dis. 57(suppl 2), S80–S89 (2013)

    Article  PubMed  Google Scholar 

  69. Jacobson, I.M., McHutchison, J.G., Dusheiko, G., et al.: Telaprevir for previously untreated chronic hepatitis C virus infection. N. Engl. J. Med. 364(25), 2405–2416 (2011)

    Article  CAS  PubMed  Google Scholar 

  70. Poordad, F., McCone Jr., J., Bacon, B.R., et al.: Boceprevir for untreated chronic HCV genotype 1 infection. N. Engl. J. Med. 364(13), 1195–1206 (2011)

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  71. National Institute for Health and Care Excellence: Technology appraisal TA106: peginterferon alfa and ribavirin for the treatment of mild chronic hepatitis C. http://guidance.nice.org.uk/TA106 (2006). Accessed Feb 2015

  72. Wright, M., Grieve, R., Roberts, J., Main, J., Thomas, H.: Health benefits of antiviral therapy for mild chronic hepatitis C: randomised controlled trial and economic evaluation. Health. Technol. Assess. 10(21), 1–113, iii (2006)

  73. Grieve, R., Roberts, J., Wright, M., et al.: Cost effectiveness of interferon alpha or peginterferon alpha with ribavirin for histologically mild chronic hepatitis C. Gut 55(9), 1332–1338 (2006)

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  74. Martin, N.K., Vickerman, P., Miners, A., et al.: Cost-effectiveness of hepatitis C virus antiviral treatment for injection drug user populations. Hepatology 55(1), 49–57 (2012)

    Article  PubMed  Google Scholar 

  75. National Institute for Health and Care Excellence: Technology appraisal 252. Telaprevir for the treatment of genotype 1 chronic hepatitis C. Updated June 2014. http://www.nice.org.uk/ta252 (2012). Accessed Feb 2015

  76. Personal Social Services Research Unit: Unit Costs of Health and Social Care. http://www.pssru.ac.uk/project-pages/unit-costs/2014/index.php (2014). Accessed Mar 2015

  77. Haymarket Media Group Ltd: Monthly Index of Medical Specialities (MIMS). http://www.mims.co.uk/ (2015) Accessed Feb 2015

  78. Bristol-Myers Squibb Pharmaceuticals Ltd: Final clinical study report AI444040 [data on file]. (2013)

  79. Hadziyannis, S.J., Sette Jr., H., Morgan, T.R., et al.: Peginterferon-alpha2a and ribavirin combination therapy in chronic hepatitis C: a randomized study of treatment duration and ribavirin dose. Ann. Intern. Med. 140(5), 346–355 (2004)

    Article  CAS  PubMed  Google Scholar 

  80. Nelson, D.R., Cooper, J.N., Lalezari, J.P., et al.: All-oral 12-week treatment with daclatasvir plus sofosbuvir in patients with hepatitis C virus genotype 3 infection: ALLY-3 phase III study. Hepatology 61(4), 1127–1135 (2015)

    Article  CAS  PubMed  PubMed Central  Google Scholar 

Download references

Acknowledgements

This study was funded by an unrestricted grant from Bristol-Myers Squibb Pharmaceuticals Ltd.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Hayley Bennett.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Bennett, H., Gordon, J., Jones, B. et al. Hepatitis C disease transmission and treatment uptake: impact on the cost-effectiveness of new direct-acting antiviral therapies. Eur J Health Econ 18, 1001–1011 (2017). https://doi.org/10.1007/s10198-016-0844-8

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10198-016-0844-8

Keywords

JEL Classification

Navigation