DOT-C: A cluster randomised feasibility trial evaluating d irectly o bserved an t i-H C V therapy in a population receiving opioid substitute therapy from community pharmacy

Radley, Andrew; Tait, Jan; Dillon, John

doi:10.1016/j.drugpo.2017.05.042

Cited by 53 publications

(59 citation statements)

References 43 publications

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“…Pharmacy‐based targeted testing for HCV has proven successful in the USA and Scotland (UK) where it is part of an ongoing trial . A qualitative study attributed the success of pharmacy‐based screening in PWID to the geographical proximity of community pharmacies and their pre‐existing relationships with pharmacy staff .…”

Section: Discussionmentioning

confidence: 99%

“…At the time of our intervention, NHS England drug commissioning restricted treatment to one patient on the IoW per month; this led to a temporal disconnect between the point of diagnosis and the potential start of treatment. Interestingly, a current UK trial is investigating the effectiveness of diagnosing and rapidly treating patients in the pharmacy setting . We feel this ‘one‐stop’ approach for HCV care is essential to optimise engagement in future…”

Section: Discussionmentioning

confidence: 99%

“…Pharmacy-based targeted testing for HCV has proven successful in the USA 19 and Scotland (UK) where it is part of an ongoing trial. 21 A qualitative study attributed the success of pharmacy-based screening in PWID to the geographical proximity of community pharmacies and their pre-existing relationships with pharmacy staff. 40 However, in our study just two of 20 pharmacies accounted for the majority of testing activity and there is little testing taking place elsewhere in England (UK)-even in areas where it has been commissioned.…”

Section: Discussionmentioning

confidence: 99%

“…Attempts have been made to address these; in the UK, national action plans have encouraged an increase in HCV testing and this has prompted initiatives such as primary care record screening for people at risk of HCV, testing in emergency departments, and prisons and widespread testing in drug support centres . In addition to these initiatives, there is also growing evidence that targeted testing for HCV in community pharmacies may be an effective approach to identify undiagnosed cases of HCV …”

Section: Introductionmentioning

confidence: 99%

“…[15][16][17][18] In addition to these initiatives, there is also growing evidence that targeted testing for HCV in community pharmacies may be an effective approach to identify undiagnosed cases of HCV. [19][20][21] However, treatment for HCV is expensive and when the costs of the directly acting antiviral drugs (DAAs) are assessed against potential benefits, they have been close to acceptable 'willingness to pay' thresholds in the USA, 22 UK 23 and Europe. 24 It is therefore important that the additional costs associated with pharmacy-based testing are considered for this service develop further.…”

Section: Introductionmentioning

confidence: 99%

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The testing of people with any risk factor for hepatitis C in community pharmacies is cost‐effective

Buchanan

Cooper

Grellier

et al. 2019

Journal of Viral Hepatitis

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New antiviral drugs with high efficacy mean the hepatitis C virus (HCV) can now be eliminated. To achieve this, it is necessary to identify undiagnosed cases of HCV. However, the costs of testing should be considered when judging the overall cost‐effectiveness of treatment. This study describes the cost‐effectiveness of a community pharmacy testing service in a population of people at risk of HCV living on the Isle of Wight (United Kingdom). Dry blood spot testing was conducted in anyone with a known risk factor for HCV in 20 community pharmacies. The outcomes and costs were entered into a Markov model. Cost and health utilities from the model were used to calculate an incremental cost‐effectiveness ratio (ICER). In 24 months, 186 tests were conducted, 13 were positive for HCV RNA and six of these (46%) received treatment during the follow‐up period. All achieved a sustained virological response at 3 months. The overall cost of the testing and treatment intervention was £242 183, and the ICER for the service was £3689 per quality‐adjusted life year (QALY) gained. If screening had been restricted to just people with a history of injecting drug use (PWID) the ICER would have been £4865 per QALY gained. The service was effective at identifying people with HCV infection, and despite the additional cost of targeted testing, its cost‐effectiveness was below the commonly accepted thresholds. In this setting, restricting targeted testing to PWID would not improve the cost‐effectiveness.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

The testing of people with any risk factor for hepatitis C in community pharmacies is cost‐effective

Buchanan

Cooper

Grellier

et al. 2019

Journal of Viral Hepatitis

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Research gaps in viral hepatitis

2018

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IntroductionThe World Health Organization has aimed for global elimination of both hepatitis B virus (HBV) and hepatitis C virus (HCV) by 2030. Treatments available to cure HCV and control HBV, as well as vaccination to prevent HBV infection, have certainly allowed for such bold goals, yet the final steps to usher in elimination require further evidence.DiscussionWe broadly discuss the needs for three major public health approaches. First, an effective vaccine exists for HBV and mass‐vaccination campaigns have resulted in decreases in hepatitis B surface antigen seroprevalence and overall rates of liver‐related morality. Still, HBV vaccination coverage is poor in certain regions of the world, while the reasons for such low coverage require further study. A prophylactic vaccine is probably needed to eliminate HCV, but is not being readily developed. Second, identifying HBV/HCV infected individuals remains a priority to increase awareness of disease status, particularly for key populations. Research evaluating large‐scale implementation of novel, rapid and mobile point‐of‐care tests would be helpful to determine whether increased awareness is achievable in these settings. Third, antiviral therapy allows for strong HBV suppression and HCV cure, while its access depends on financial factors among many others. Although there is strong evidence to treat key populations and specific groups with progressed disease, as stated in current guidelines, the advantages of extending treatment eligibility to decrease onward spread of HBV/HCV infection and prevent further burden of disease are lacking “real world” evidence. Novel anti‐HBV treatments are being developed to target intrahepatocellular HBV replication, but are still in the early phases of clinical development. Each of the strategies mentioned above has specific implications for HIV infection.ConclusionsThere are certainly effective tools to combat the spread of viral hepatitis and treat infected individuals – yet how they are able to reach key populations, and the infrastructure required to do so, continue to represent the largest research gap when evaluating the progress towards elimination. Continuously adapted and informed research is required to establish the priorities in achieving elimination goals.

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