Epidemiology of hepatitis C virus infection in a country with universal access to direct-acting antiviral agents: Data for designing a cost-effective elimination policy in Spain.
cost-effectiveness
direct-acting antiviral agents
epidemiologic
hepatitis C
prevalence
Journal
Journal of viral hepatitis
ISSN: 1365-2893
Titre abrégé: J Viral Hepat
Pays: England
ID NLM: 9435672
Informations de publication
Date de publication:
04 2020
04 2020
Historique:
received:
05
08
2019
revised:
30
10
2019
accepted:
05
11
2019
pubmed:
23
11
2019
medline:
7
8
2021
entrez:
23
11
2019
Statut:
ppublish
Résumé
Accurate HCV prevalence estimates are necessary for guiding elimination policies. Our aim was to determine the HCV prevalence and assess the cost-effectiveness of a screen-and-treat strategy in the Spanish population. A population-based, cross-sectional study (PREVHEP-ETHON Cohort, Epidemiological sTudy of Hepatic infectiONs; NCT02749864) was performed from July 2015-April 2017. Participants from three Spanish regions were selected using two-stage conglomerate sampling, and stratified by age, with randomized subject selection. Anthropometric and demographic data were collected, and blood samples were taken to detect anti-HCV antibodies/quantify HCV RNA. The cost-effectiveness of the screening strategies and treatment were analysed using a Markov model. Among 12 246 participants aged 20-74 (58.4% females), the overall anti-HCV prevalence was 1.2% (95% CI 1.0-1.4), whereas the detectable HCV-RNA prevalence was 0.3% (0.2-0.4). Infection rates were highest in subjects aged 50-74 years [anti-HCV 1.6% (1.3-1.9), HCV RNA 0.4% (0.3-0.6]. Among the 147 anti-HCV + subjects, 38 (25.9%) had active infections while 109 (74.1%) had been cleared of infection; 44 (40.4%) had cleared after antiviral treatment, whereas 65 (59.6%) had cleared spontaneously. Overall, 59.8% of the anti-HCV + participants were aware of their serological status. Considering a cost of treatment of €7000/patient, implementing screening programmes is cost-effective across all age cohorts, particularly in patients aged 50-54 (negative incremental cost-effectiveness ratio which indicates a cost-saving strategy). The current HCV burden is lower than previously estimated, with approximately 25% of anti-HCV + individuals having an active infection. A strategy of screening and treatment at current treatment prices in Spain is cost-effective across all age cohorts.
Substances chimiques
Antiviral Agents
0
Types de publication
Journal Article
Observational Study
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
360-370Informations de copyright
© 2019 John Wiley & Sons Ltd.
Références
Blachier M, Leleu H, Peck-Radosavljevic M, Valla DC, Roudot-Thoraval F. The burden of liver disease in Europe: a review of available epidemiological data. J Hepatol. 2013;58:593-608.
United Nations General. Assembly Resolution A/RES/70/1. Transforming Our World: The 2030 Agenda for Sustainable Development. http://www.un.org/en/development/desa/population/migration/generalassembly/docs/globalcompact/A_RES_70_1_E.pdf. Accessed November 2018.
World Health Organization. Hepatitis C Fact Sheet. http://www.who.int/mediacentre/factsheets/fs164/en/. Accessed November 2018.
World Health Organization. Draft Global Health Sector Strategy on Viral Hepatitis, 2016-2021 - The First of its Kind. http://www.who.int/hepatitis/strategy2016-2021/Draft_global_health_sector_strategy_viral_hepatitis_13nov.pdf. Accessed November 2018.
World Health Organization. Combating Hepatitis B and C to Reach Elimination by 2030. http://apps.who.int/iris/bitstream/handle/10665/206453/WHO_HIV_2016.04_eng.pdf;jsessionxml:id=5F7B95D01C898DF2C9C537EDF5ED25D3?sequence=1. Accessed November 2018.
Gower E, Estes C, Blach S, Razavi-Shearer K, Razavi H. Global epidemiology and genotype distribution of the hepatitis C virus infection. J Hepatol. 2014;61:S45-S57.
World Health Organization. Guidelines on Hepatitis B and C Testing. http://apps.who.int/iris/bitstream/handle/10665/254621/9789241549981-eng.pdf;jsessionxml:id=F2F7174AE95B64B3B4868F149AF580CD?sequence=1. Accessed November 2018.
García Comas L, Ordobás Gavín M, Sanz Moreno JC, et al. Prevalence of hepatitis C antibodies in the population aged 16-80 years in the community of Madrid 2008-2009. J Med Virol. 2015;87:1697-1701.
Muhlberger N, Schwarzer R, Lettmeier B, Sroczynski G, Zeuzem S, Siebert U. HCV-related burden of disease in Europe: a systematic assessment of incidence, prevalence, morbidity, and mortality. BMC Public Health. 2009;9:34.
Bruggmann P, Berg T, Øvrehus ALH, et al. Historical epidemiology of hepatitis C virus (HCV) in selected countries. J Viral Hepat. 2014;21:5-33.
Razavi H, Robbins S, Zeuzem S, et al. Hepatitis C virus prevalence and level of intervention required to achieve the WHO targets for elimination in the European Union by 2030: a modelling study. Lancet Gastroenterol Hepatol. 2017;2:325-336.
Deuffic S, Poynard T, Valleron AJ. Correlation between hepatitis C virus prevalence and hepatocellular carcinoma mortality in Europe. J Viral Hepat. 1999;6:411-413.
El-Serag HB. Epidemiology of viral hepatitis and hepatocellular carcinoma. Gastroenterology. 2012;142:1264-1273.e1.
Tanaka Y, Kurbanov F, Mano S, et al. Molecular tracing of the global hepatitis C virus epidemic predicts regional patterns of hepatocellular carcinoma mortality. Gastroenterology. 2006;130:703-714.
European Statistical System. Census Data. https://ec.europa.eu/CensusHub2/query.do?step=selectHyperCube&qhc=false. Accessed March 15, 2016.
Institut de Veille Sanitaire. Prevalence of Hepatitis B and Hepatitis C in France, 2004 [Article in French]. http://invs.santepubliquefrance.fr/publications/2006/prevalence_b_c/vhb_france_2004.pdf. Accessed March 2018.
Ditah I, Ditah F, Devaki P, et al. The changing epidemiology of hepatitis C virus infection in the United States: National Health and Nutrition Examination Survey 2001 through 2010. J Hepatol. 2014;60:691-698.
Smith BD, Morgan RL, Beckett GA, et al. Recommendations for the identification of chronic hepatitis C virus infection among persons born during 1945-1965. MMWR Recomm Rep. 2012;61:1-32.
Bastida JL, Oliva J, Antonanzas F, et al. A proposed guideline for economic evaluation of health technologies. Gac Sanit. 2010;24:154-170.
SEIMC. Guía del Manejo de la Hepatitis C en España. 2016. https://www.seimc.org/contenidos/documentoscientificos/guiasclinicas/seimc-clinicasclinicas-2016-Manejo_HepatitisC.pdf. Accessed November 2018.
Buti M, Medina M, Casado MA, Wong JB, Fosbrook L, Esteban R. A cost-effectiveness analysis of peginterferon alfa-2b plus ribavirin for the treatment of naive patients with chronic hepatitis C. Aliment Pharmacol Ther. 2003;17:687-694.
Chhatwal J, Ferrante SA, Brass C, et al. Cost-effectiveness of boceprevir in patients previously treated for chronic hepatitis C genotype 1 infection in the United States. Value Health. 2013;16:973-986.
Elbasha EH, Chhatwal J, Ferrante SA, El Khoury AC, Laires PA. Cost-effectiveness analysis of boceprevir for the treatment of chronic hepatitis C virus genotype 1 infection in Portugal. Appl Health Econ Health Policy. 2013;11:65-78.
Elbasha EH, Robertson MN, Nwankwo C. The cost-effectiveness of testing for NS5a resistance-associated polymorphisms at baseline in genotype 1a-infected (treatment-naive and treatment-experienced) subjects treated with all-oral elbasvir/grazoprevir regimens in the United States. Aliment Pharmacol Ther. 2017;45:455-467.
Ferrante SA, Chhatwal J, Brass CA, et al. Boceprevir for previously untreated patients with chronic hepatitis C Genotype 1 infection: a US-based cost-effectiveness modeling study. BMC Infect Dis. 2013;13:190.
Salomon JA, Weinstein MC, Hammitt JK, Goldie SJ. Cost-effectiveness of treatment for chronic hepatitis C infection in an evolving patient population. JAMA. 2003;290:228-237.
Siebert U, Sroczynski G, Rossol S, et al. Cost effectiveness of peginterferon alpha-2b plus ribavirin versus interferon alpha-2b plus ribavirin for initial treatment of chronic hepatitis C. Gut. 2003;52:425-432.
Sullivan SD, Craxi A, Alberti A, et al. Cost effectiveness of peginterferon alpha-2a plus ribavirin versus interferon alpha-2b plus ribavirin as initial therapy for treatment-naive chronic hepatitis C. Pharmacoeconomics. 2004;22:257-265.
Younossi ZM, Singer ME, McHutchison JG, Shermock KM. Cost effectiveness of interferon alpha2b combined with ribavirin for the treatment of chronic hepatitis C. Hepatology. 1999;30:1318-1324.
Foundation CDA. Polaris Observatory Dashboard. http://cdafound.org/polaris-hepc-dashboard/. Accessed November 2018.
Hofstraat SHI, Falla AM, Duffell EF, et al. Current prevalence of chronic hepatitis B and C virus infection in the general population, blood donors and pregnant women in the EU/EEA: a systematic review. Epidemiol Infect. 2017;145:2873-2885.
Harris M, Rhodes T. Hepatitis C treatment access and uptake for people who inject drugs: a review mapping the role of social factors. Harm Reduct J. 2013;10:7.
Harris M, Rhodes T, Martin A. Taming systems to create enabling environments for HCV treatment: negotiating trust in the drug and alcohol setting. Soc Sci Med. 2013;83:19-26.
Rhodes T, Harris M, Martin A. Negotiating access to medical treatment and the making of patient citizenship: the case of hepatitis C treatment. Sociol Health Illn. 2013;35:1023-1044.
Cimavilla M, Garrido-Lopez S, Almohalla C, et al. Is An Active Search Program for HCV Useful to Increase the Rate of Treatment? Washington, DC: AASLD: The Liver Meeting; 2017.
Hill A, Kahn A, Nath S, Simmons B. Diagnostic Burn-out" for Hepatitis C: When will Countries Run Out of Diagnosed People to Treat with DAAs? Washington, DC: AASLD: The Liver Meeting; 2017.
Vallejo-Torres L, García-Lorenzo B, Castilla I, Valcárcel Nazco C, GarcíaPérez L, Linertová R, Serrano-Aguilar P. Valor Monetario de un Año de Vida Ajustado Por Calidad: Estimación Empírica del Coste de Oportunidad en el Sistema Nacional de Salud. Ministerio de Sanidad, Servicios Sociales e Igualdad. Servicio de Evaluación del Servicio Canario de la Salud, Madrid, Spain: Informes de Evaluación de Tecnologías Sanitarias; 2015.
NICE. The Guidelines Manual. Assessing Cost Effectiveness. https://www.nice.org.uk/process/pmg6/chapter/assessing-cost-effectiveness. Accessed November 2018.
Strategy for the Elimination of Hepatitis C in Cantabria. https://www.scsalud.es/documents/2162705/2529917/Hepatitis+C.pdf/089a743c-d758-2383-6d1b-0ab059f5887a. Accessed October 2019.
Iyengar S, Tay-Teo K, Vogler S, et al. Prices, costs, and affordability of new medicines for hepatitis c in 30 countries: an economic analysis. PLoS Med. 2016;13:e1002032.
Gountas I, Sypsa V, Papatheodoridis G, et al. Economic evaluation of the hepatitis C elimination strategy in Greece in the era of affordable direct-acting antivirals. World J Gastroenterol. 2019;25:1327-1340.
Cortesi PA, Barca R, Giudicatti G, et al. Systematic review: economic evaluations of HCV screening in the direct-acting antivirals era. Aliment Pharmacol Ther. 2019;49:1126-1133.
Lazarus J, Safreed-Harmon K, Thursz M, et al. The micro-elimination approach to eliminating hepatitis C: strategic and operational considerations. Semin Liver Dis. 2018;38:181-192.