Bennett Hayley, McEwan Phil, Sugrue Daniel, Kalsekar Anupama, Yuan Yong
Health Economics & Outcomes Research Ltd., Cardiff, Wales, United Kingdom.
Health Economics & Outcomes Research Ltd., Cardiff, Wales, United Kingdom; Swansea Centre for Health Economics, Swansea University, Swansea, Wales, United Kingdom.
PLoS One. 2015 May 4;10(5):e0125846. doi: 10.1371/journal.pone.0125846. eCollection 2015.
The prevalence of the hepatitis C virus (HCV) remains high amongst people who inject drugs (PWID) and accounts for the majority of newly acquired infections. This study aims to quantify the value of treatment amongst PWID with more efficacious treatments and at increased uptake rates, with respect to the avoidance of future infections and subsequent long-term complications of HCV.
A dynamic HCV transmission and disease progression model was developed, incorporating acute and chronic infection and their long-term complications (decompensated cirrhosis, cancer, liver transplant and mortality), with the potential for HCV transmission to other PWID prior to successful treatment. The model was populated with prevalence and therapy data from a UK setting. Scenarios of current standard of care (SoC) treatment efficacy and uptake were compared to anticipated sustained virologic response (SVR) rates of 90-100% and increased uptake over varied horizons.
SoC led to modest reductions in prevalence; >5% after 200 years. New treatments achieving 90% SVR could reduce prevalence below 5% within 60 years at current uptake rates or within 5 years if all patients are treated. Amongst 4,240 PWID, chronic HCV infections avoided as a result of increasing treatment uptake over the period 2015-2027 ranged from 20-580 and 34-912 with SoC and 90% SVR rates respectively. The reduction in downstream HCV infections due to increasing treatment uptake resulted in an approximate discounted gain of 300 life-years (from avoiding reduced life expectancy from HCV infection) and a gain of 1,700 QALYs (from avoiding the disutility of HCV infection and related complications), with a projected £5.4 million cost saving.
While improved SVR profiles led to reductions in modelled prevalence, increased treatment uptake was the key driver of future infections avoided. Increased treatment among PWID with new more efficacious therapies could significantly change the future dynamics, cost and health burden of HCV-related disease.
丙型肝炎病毒（HCV）在注射吸毒者（PWID）中的流行率仍然很高，且占新感染病例的大多数。本研究旨在量化在PWID中采用更有效的治疗方法并提高治疗接受率时，治疗对于避免未来感染以及后续HCV长期并发症的价值。
建立了一个动态HCV传播和疾病进展模型，纳入急性和慢性感染及其长期并发症（失代偿性肝硬化、癌症、肝移植和死亡），且在成功治疗前存在HCV传播给其他PWID的可能性。该模型采用了来自英国的流行率和治疗数据。将当前标准治疗（SoC）的疗效和接受率情况与预期的90%-100%持续病毒学应答（SVR）率以及不同时间范围内提高的接受率进行了比较。
SoC导致流行率适度下降；200年后下降幅度超过5%。新的治疗方法若能达到90%的SVR，在当前接受率下60年内可将流行率降至5%以下，若所有患者都接受治疗则在5年内可实现。在4240名PWID中，2015年至2027年期间因治疗接受率提高而避免的慢性HCV感染，采用SoC时为20 - 580例，采用90% SVR率时为34 - 912例。因治疗接受率提高而导致的下游HCV感染减少带来了约300个贴现生命年的收益（因避免HCV感染导致的预期寿命缩短）以及1700个质量调整生命年的收益（因避免HCV感染及相关并发症的负效用），预计节省成本540万英镑。
虽然改善的SVR情况导致模型中的流行率下降，但提高治疗接受率是避免未来感染的关键驱动因素。在PWID中采用新的更有效的疗法增加治疗，可能会显著改变HCV相关疾病的未来动态、成本和健康负担。
