Ward Zoe, Simmons Ruth, Fraser Hannah, Trickey Adam, Kesten Jo, Gibson Andy, Reid Leila, Cox Sean, Gordon Fiona, Mc Pherson Stuart, Ryder Stephen, Vilar Javier, Miners Alec, Williams Jack, Emmanouil Beatrice, Desai Monica, Coughlan Laura, Harris Ross, Foster Graham R, Hickman Matthew, Mandal Sema, Vickerman Peter
Bristol Medical School, University of Bristol, Bristol, UK.
UK Health Security Agency, London, UK.
Lancet Reg Health Eur. 2024 Dec 12;49:101176. doi: 10.1016/j.lanepe.2024.101176. eCollection 2025 Feb.
England aims to reach the World Health Organization (WHO) elimination target of decreasing HCV incidence among people who inject drugs (PWID) to <2 per 100 person-years (/100pyrs) by 2030. We assessed what testing and treatment strategies will achieve this target and whether they are cost-effective.
A dynamic deterministic HCV transmission model among PWID was developed for four England regions, utilising data on the scale-up of HCV treatment among PWID in prisons, drug treatment centres (DTC, where opioid agonist therapy is provided), and any other setting (e.g., primary care). The model projected whether the elimination target will be reached with existing testing and treatment initiatives ('status quo' model, SQ), or whether improvements are needed from 2024. Cost data was collated through practitioners' interviews and published literature. The mean incremental cost-effectiveness ratio (ICER per quality adjusted life year (QALY) saved, 50-year time horizon; 3.5% discount rate) of SQ (assumes counterfactual of no treatment scale-up post-2015) and improved model (counterfactual: SQ model) was compared to a willingness-to-pay threshold of £20,000/QALY saved.
The SQ model projects HCV incidence will decrease by 79.7-98.6% (range of medians) over 2015-2030 to 0.2-2.2/100pyrs, with an ICER of £308-1609/QALY saved across the regions. There is >80% probability of achieving the incidence target in three regions, and 40% probability in the other region. If annual testing in DTC increases to 80% (from 27%) or 75% of people get tested during their prison stay (from 55%) from 2024 in the lower impact region, then their probability increases to >65%, with both strategies being highly cost-effective.
Many England regions could reach the WHO HCV elimination target by 2030 under existing testing and treatment pathways. Scaling up of testing in DTC or prisons will help achieve this target and is highly cost-effective.
NIHR.
英国旨在实现世界卫生组织（WHO）的消除目标，即到2030年将注射吸毒者（PWID）中的丙型肝炎病毒（HCV）发病率降至每100人年<2例（/100pyrs）。我们评估了哪些检测和治疗策略将实现这一目标以及它们是否具有成本效益。
利用监狱、戒毒治疗中心（DTC，提供阿片类激动剂治疗）以及任何其他场所（如初级保健）中PWID扩大HCV治疗规模的数据，为英国四个地区开发了一个动态确定性HCV传播模型。该模型预测现有检测和治疗举措（“现状”模型，SQ）是否能实现消除目标，或者从2024年起是否需要改进。成本数据通过从业者访谈和已发表文献收集。将SQ（假设2015年后无治疗规模扩大的反事实情况）和改进模型（反事实情况：SQ模型）的平均增量成本效益比（每挽救一个质量调整生命年（QALY）的ICER，50年时间范围；3.5%贴现率）与每挽救一个QALY支付意愿阈值20,000英镑进行比较。
SQ模型预测，2015 - 2030年期间HCV发病率将下降79.7 - 98.6%（中位数范围）至0.2 - 2.2/100pyrs，各地区每挽救一个QALY的ICER为308 - 1609英镑。三个地区实现发病率目标的概率>80%，另一个地区为40%。如果在影响较小的地区，从2024年起DTC的年度检测率提高到80%（从27%）或75%的人在监狱服刑期间接受检测（从55%），那么他们实现目标的概率将提高到>65%，且这两种策略都具有很高的成本效益。
在现有检测和治疗途径下，英国许多地区到2030年可能实现WHO的HCV消除目标。扩大DTC或监狱中的检测将有助于实现这一目标，且具有很高的成本效益。
英国国家卫生研究院（NIHR）
