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. 2019 Jan 10;14(1):e0210179.
doi: 10.1371/journal.pone.0210179. eCollection 2019.

Early treatment of acute hepatitis C infection is cost-effective in HIV-infected men-who-have-sex-with-men

Stephanie Popping  1 , Sebastiaan J Hullegie  2 , Anne Boerekamps  2 , Bart J A Rijnders  2 , Robert J de Knegt  3 , Jürgen K Rockstroh  4 , Annelies Verbon  2 , Charles A B Boucher  1 , Brooke E Nichols  1   5 , David A M C van de Vijver  1
Affiliations

Early treatment of acute hepatitis C infection is cost-effective in HIV-infected men-who-have-sex-with-men

Stephanie Popping et al. PLoS One. .

Abstract

Background: Treatment of hepatitis C virus infections (HCV) with direct acting antivirals (DAA) can prevent new infections since cured individuals cannot transmit HCV. However, as DAAs are expensive, many countries defer treatment to advances stages of fibrosis, which results in ongoing transmission. We assessed the epidemiological impact and cost-effectiveness of treatment initiation in different stages of infection in the Netherlands where the epidemic is mainly concentrated among HIV-infected MSMs.

Methods: We calibrated a deterministic mathematical model to the Dutch HCV epidemic among HIV-infected MSM to compare three different DAA treatment scenarios: 1) immediate treatment, 2) treatment delayed to chronic infection allowing spontaneous clearance to occur, 3) treatment delayed until F2 fibrosis stage. All scenarios are simulated from 2015 onwards. Total costs, quality adjusted life years (QALY), incremental cost-effectiveness ratios (ICERs), and epidemiological impact were calculated from a providers perspective over a lifetime horizon. We used a DAA price of €35,000 and 3% discounting rates for cost and QALYs.

Results: Immediate DAA treatment lowers the incidence from 1.2/100 person-years to 0.2/100 person-years (interquartile range 0.1-0.2) and the prevalence from 5.0/100 person-years to 0.5/100 person-years (0.4-0.6) after 20 years. Delayed treatment awaiting spontaneous clearance will result in a similar reduction. However, further delayed treatment to F2 will increases the incidence and prevalence. Earlier treatment will cost society €68.3 and €75.1 million over a lifetime for immediate and awaiting until the chronic stage, respectively. The cost will increase if treatment is further delayed until F2 to €98.4 million. Immediate treatment will prevent 7070 new infections and gains 3419 (3019-3854) QALYs compared to F2 treatment resulting in a cost saving ICER. Treatment in the chronic stage is however dominated.

Conclusions: Early DAA treatment for HIV-infected MSM is an excellent and sustainable tool to meet the WHO goal of eliminating HCV in 2030.

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Conflict of interest statement

Stephanie Popping: reports funding in the form of a unrestricted educational grant by Gilead Sciences [NL-2018-000171] and grants from Gilead [215001269], MSD [SDD 343462], ViiV Healthcare [14-0614-ViiV], and Janssen [771290]. Sebastiaan J. Hullegie: reports grants from Merck [MSD IISA 11/jul/2015], during the conduct of the study; non-financial support from Gilead, non-financial support from MSD, outside the submitted work Anne Boerekamps: reports no conflict of interest Bart J.A. Rijnders: reports grants from MSD [MSD IISA 11/jul/2015], Gilead [IN-NL-987- 4558/4652/4653] and honoraria from Jansen-Cilag, BMS, Pfizer and Viiv Robert J. de Knegt: Reports honoraria for consulting or speaking (last 5 years): AbbVie, BMS, Gilead, Janssen-Cilag, Merck/MSD, Roche. Jürgen K. Rockstroh: reports honaria for lectures and/or consultancies from Abbott, AbbVie, Bionor, BMS, Cipla, Gilead, Janssen, Merck, Roche, Viiv A.Verbon: reports no conflict of interest, Charles A.B. Boucher: reports grants from Gilead sciences [NL-2018-000171] and [215001269], MSD [SDD 343462], ViiV Healthcare [14-0614-ViiV], Janssen [771290], and Boehringer [S14064/32844]]. Brooke E. Nichols: no conflict of interest, David A.M.C. van de Vijver: reports grants from Gilead sciences [NL-2018-000171] and [215001269], MSD [SDD 343462], ViiV Healthcare [14-0614-ViiV], and Janssen [771290]. None of these competing interests alter our adherence to PLOS ONE policies on sharing data and materials. We confirm that none of the funders had a role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.

Figures

Fig 1
Fig 1. Short term epidemiological hepatitis c virus impact among HIV positive men who have sex with men.
In the upper figure, the hepatitis C virus incidence is projected and in the lower figure the hepatitis C virus prevalence. Three different treatment scenarios were simulated over a short term period of 20 years. F2, delaying treatment until a F2 fibrosis stage. F0 chronic, awaiting the time frame of spontaneously clearance. Acute HCV, treatment in the acute stage. Median rates are reported. Abbreviations: HCV = hepatitis C virus.
Fig 2
Fig 2. One-way sensitivity analysis of the incremental cost-effectiveness ratio(ICERs) (€/QALY) of direct acting antiviral treatment (DAA).
– DAA Treatment in the acute stage of infection is compared to delayed F2 DAA treatment with varying different key parameters. The bars show the range in ICER if these key variables are varied. All ICERs are stated in euros. Abbreviations: DAA: direct-acting antivirals, ICER: incremental cost-effectiveness ratio, MSM men-who-have-sex-with-men.
See this image and copyright information in PMC

References

    1. Tapper EB, Bacon BR, Curry MP, Dieterich DT, Flamm SL, Guest LE, et al. Real-world effectiveness for 12 weeks of ledipasvir-sofosbuvir for genotype 1 hepatitis C: the Trio Health study. J Viral Hepat. 2017;24(1):22–7. 10.1111/jvh.12611 - DOI - PubMed
    1. Backus LI, Belperio PS, Shahoumian TA, Loomis TP, Mole LA. Real-world effectiveness of ledipasvir/sofosbuvir in 4,365 treatment-naive, genotype 1 hepatitis C-infected patients. Hepatology. 2016;64(2):405–14. 10.1002/hep.28625 - DOI - PubMed
    1. Boerekamps A, van den Berk GE, Lauw FN, Leyten EM, van Kasteren ME, van Eeden A, et al. Declining Hepatitis C Virus (HCV) Incidence in Dutch Human Immunodeficiency Virus-Positive Men Who Have Sex With Men After Unrestricted Access to HCV Therapy. Clin Infect Dis. 2018;66(9):1360–5. 10.1093/cid/cix1007 - DOI - PubMed
    1. Martin NK, Thornton A, Hickman M, Sabin C, Nelson M, Cooke GS, et al. Can HCV direct-acting antiviral treatment as prevention reverse the HCV epidemic amongst men who have sex with men in the UK—epidemiological and modelling insights. Clin Infect Dis. 2016. - PMC - PubMed
    1. Global Hepatitis Report 2017. Geneva: World Health Organization; 2017. Geneva: 2017 CC BY-NC-SA 3.0 IGO.

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