Elimination of hepatitis C virus in Germany: modelling the cost-effectiveness of HCV screening strategies

Abstract

BackgroundChronic hepatitis C is a major public health burden. With new interferon-free direct-acting agents (showing sustained viral response rates of more than 98%), elimination of HCV seems feasible for the first time. However, as HCV infection often remains undiagnosed, screening is crucial for improving health outcomes of HCV-patients. Our aim was to assess the long-term cost-effectiveness of a nationwide screening strategy in Germany.MethodsWe used a Markov cohort model to simulate disease progression and examine long-term population outcomes, HCV associated costs and cost-effectiveness of HCV screening. The model divides the total population into three subpopulations: general population (GEP), people who inject drugs (PWID) and HIV-infected men who have sex with men (MSM), with total infection numbers being highest in GEP, but new infections occurring only in PWIDs and MSM. The model compares four alternative screening strategies (no/basic/advanced/total screening) differing in participation and treatment rates.ResultsTotal number of HCV-infected patients declined from 275,000 in 2015 to between 125,000 (no screening) and 14,000 (total screening) in 2040. Similarly, lost quality adjusted life years (QALYs) were 320,000 QALYs lower, while costs were 2.4 billion EUR higher in total screening compared to no screening. While incremental cost-effectiveness ratio (ICER) increased sharply in GEP and MSM with more comprehensive strategies (30,000 EUR per QALY for total vs. advanced screening), ICER decreased in PWIDs (30 EUR per QALY for total vs. advanced screening).ConclusionsScreening is key to have an efficient decline of the HCV-infected population in Germany. Recommendation for an overall population screening is to screen the total PWID subpopulation, and to apply less comprehensive advanced screening for MSM and GEP.

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

“…Neither of the two treatment groups showed any relevant adverse events. While some bigger studies may have found even higher SVR12-rates, our findings mainly concur with current literature and support the recommendations of broad access to DAA treatment, especially for high-risk populations [ 12 , 17 – 20 , 22 , 37 , 38 , 44 , 45 , 55 , 56 ]. Still, bigger sample sizes will be needed to validate our results.…”

The cost‐effectiveness of case‐finding strategies for achieving hepatitis C elimination among men who have sex with men in the UK

“…Other studies have estimated the cost‐effectiveness of enhancing HCV screening in MSM. Firstly, two studies using models that do not account for dynamic HCV transmission showed it was cost‐saving to undertake one‐time screening among HIV‐positive MSM in Germany, 47 and cost‐effective (<€10,000/QALY) to undertaken one‐time or yearly screening among all MSM in Belgium 48 . Otherwise, a dynamic transmission modelling analysis from Netherlands 49 and another model analysis incorporating incidence and reinfection from the USA 50 have shown it was cost‐effective or cost‐saving to undertake screening and/or treatment interventions among HIV‐diagnosed MSM.…”

Modeling the Puzzle of Hepatitis C Epidemiology in Romania: A Pathway to Control

“…Historically, research on hepatitis C progression has been conducted by using Markov chains over the natural history of the disease [42], published by Salomon et. al [1,43], with estimates on the disease progression, associated costs and the number of patients infected with HCV, by age and gender [44][45][46].…”