Targeted HCV core antigen monitoring among HIV-positive men who have sex with men is cost-saving
|Bart Rijnders et al.|
AbstractIntroduction: The World Health Organization declared the goal of hepatitis C virus (HC V) elimination by 2030. Micro-elimination, which is the reduction of incidence to zero in targeted populations, is less complex and costly and may be the first step to prove whether elimination is feasible. A suitable target group are HI V-positive men who have sex with men (MSM) because of their high-risk behaviour and high incidence rates. Moreover, HC V monitoring is integrated in HI V care. The current HC V monitoring approach is suboptimal and complex and may miss new HC V infections. Alternative monitoring strategies, based on alanine aminotransferase, HC V-PCR and HC V-core antigen (HC V-cAg), combined with immediate direct-acting antiviral (DAA ) treatment, may be more effective in reducing new HC V infections. Methods: A deterministic mathematical transmission model was constructed representing the Dutch HC V epidemic among HI V-positive MSM to compare different HC V monitoring strategies from 2018 onwards. We evaluated the epidemiological impact of alternative and intensified monitoring in MSM with HC V. In addition, the cost-effectiveness was calculated over a lifetime horizon. Results: Current HC V monitoring and treatment is projected to result in an incidence of 1.1/1000 person-years, 0.24% prevalence, at a cost of €61.8 million (interquartile range 52.2–73.9). Compared with current monitoring, intensified monitoring will result in a maximum 27% reduction of incidence and 33% in prevalence at an increased cost. Conversely, compared with current monitoring, targeted HC V-cAg monitoring will result in a comparable incidence (1.1/1000 person-years) and prevalence (0.23%) but will be €1 million cheaper with increased quality-adjusted life year. Conclusion: Targeted monitoring reduces the HC V epidemic in a cost-saving manner; however, micro-elimination may not be obtained by 2030, highlighting the need for harm-reduction programmes.
Hepatitis C (HCV)