Targeted HCV core antigen monitoring among HIV-positive men who have sex with men is cost-saving

Introduction: The World Health Organization declared the goal of hepatitis C virus (HCV) 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 suita...

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Main Authors: Stephanie Popping, Brooke Nichols, Bart Rijnders, Jeroen van Kampen, Annelies Verbon, Charles Boucher, David van de Vijver
Format: Article
Language:English
Published: Elsevier 2019-10-01
Series:Journal of Virus Eradication
Subjects:
Online Access:http://www.sciencedirect.com/science/article/pii/S2055664020300315
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author Stephanie Popping
Brooke Nichols
Bart Rijnders
Jeroen van Kampen
Annelies Verbon
Charles Boucher
David van de Vijver
author_facet Stephanie Popping
Brooke Nichols
Bart Rijnders
Jeroen van Kampen
Annelies Verbon
Charles Boucher
David van de Vijver
author_sort Stephanie Popping
collection DOAJ
description Introduction: The World Health Organization declared the goal of hepatitis C virus (HCV) 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 HIV-positive men who have sex with men (MSM) because of their high-risk behaviour and high incidence rates. Moreover, HCV monitoring is integrated in HIV care. The current HCV monitoring approach is suboptimal and complex and may miss new HCV infections. Alternative monitoring strategies, based on alanine aminotransferase, HCV-PCR and HCV-core antigen (HCV-cAg), combined with immediate direct-acting antiviral (DAA) treatment, may be more effective in reducing new HCV infections. Methods: A deterministic mathematical transmission model was constructed representing the Dutch HCV epidemic among HIV-positive MSM to compare different HCV monitoring strategies from 2018 onwards. We evaluated the epidemiological impact of alternative and intensified monitoring in MSM with HCV. In addition, the cost-effectiveness was calculated over a lifetime horizon. Results: Current HCV 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 HCV-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 HCV epidemic in a cost-saving manner; however, micro-elimination may not be obtained by 2030, highlighting the need for harm-reduction programmes.
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spelling doaj.art-b7283865eaa6424a988d33bbe82c4b562022-12-21T19:05:36ZengElsevierJournal of Virus Eradication2055-66402019-10-0154179190Targeted HCV core antigen monitoring among HIV-positive men who have sex with men is cost-savingStephanie Popping0Brooke Nichols1Bart Rijnders2Jeroen van Kampen3Annelies Verbon4Charles Boucher5David van de Vijver6Department of Viroscience, Erasmus MC, Rotterdam, the Netherlands; Corresponding author: Stephanie Popping: Department of Viroscience, Erasmus Medical Center, Postbus 2040, 3000 CA, Rotterdam, the NetherlandsDepartment of Viroscience, Erasmus MC, Rotterdam, the Netherlands; Department of Global Health, Boston University, Boston, United StatesDepartment of Medical Microbiology and Infectious Diseases, Erasmus MC, Rotterdam, The NetherlandsDepartment of Viroscience, Erasmus MC, Rotterdam, the NetherlandsDepartment of Medical Microbiology and Infectious Diseases, Erasmus MC, Rotterdam, The NetherlandsDepartment of Viroscience, Erasmus MC, Rotterdam, the NetherlandsDepartment of Viroscience, Erasmus MC, Rotterdam, the NetherlandsIntroduction: The World Health Organization declared the goal of hepatitis C virus (HCV) 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 HIV-positive men who have sex with men (MSM) because of their high-risk behaviour and high incidence rates. Moreover, HCV monitoring is integrated in HIV care. The current HCV monitoring approach is suboptimal and complex and may miss new HCV infections. Alternative monitoring strategies, based on alanine aminotransferase, HCV-PCR and HCV-core antigen (HCV-cAg), combined with immediate direct-acting antiviral (DAA) treatment, may be more effective in reducing new HCV infections. Methods: A deterministic mathematical transmission model was constructed representing the Dutch HCV epidemic among HIV-positive MSM to compare different HCV monitoring strategies from 2018 onwards. We evaluated the epidemiological impact of alternative and intensified monitoring in MSM with HCV. In addition, the cost-effectiveness was calculated over a lifetime horizon. Results: Current HCV 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 HCV-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 HCV epidemic in a cost-saving manner; however, micro-elimination may not be obtained by 2030, highlighting the need for harm-reduction programmes.http://www.sciencedirect.com/science/article/pii/S2055664020300315HIVhepatitis Ccost-effectivenessdiagnosticsmen who have sex with menelimination
spellingShingle Stephanie Popping
Brooke Nichols
Bart Rijnders
Jeroen van Kampen
Annelies Verbon
Charles Boucher
David van de Vijver
Targeted HCV core antigen monitoring among HIV-positive men who have sex with men is cost-saving
Journal of Virus Eradication
HIV
hepatitis C
cost-effectiveness
diagnostics
men who have sex with men
elimination
title Targeted HCV core antigen monitoring among HIV-positive men who have sex with men is cost-saving
title_full Targeted HCV core antigen monitoring among HIV-positive men who have sex with men is cost-saving
title_fullStr Targeted HCV core antigen monitoring among HIV-positive men who have sex with men is cost-saving
title_full_unstemmed Targeted HCV core antigen monitoring among HIV-positive men who have sex with men is cost-saving
title_short Targeted HCV core antigen monitoring among HIV-positive men who have sex with men is cost-saving
title_sort targeted hcv core antigen monitoring among hiv positive men who have sex with men is cost saving
topic HIV
hepatitis C
cost-effectiveness
diagnostics
men who have sex with men
elimination
url http://www.sciencedirect.com/science/article/pii/S2055664020300315
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