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Population Health and Cost-Effectiveness Implications of a “Treat All” Recommendation for HCV: A Review of the Model-Based Evidence

The World Health Organization HCV Guideline Development Group is considering a “treat all” recommendation for persons infected with hepatitis C virus (HCV). We reviewed the model-based evidence of cost-effectiveness and population health impacts comparing expanded treatment policies to more limited...

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Autores principales: Cipriano, Lauren E., Goldhaber-Fiebert, Jeremy D.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: SAGE Publications 2018
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6157435/
https://www.ncbi.nlm.nih.gov/pubmed/30288448
http://dx.doi.org/10.1177/2381468318776634
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author Cipriano, Lauren E.
Goldhaber-Fiebert, Jeremy D.
author_facet Cipriano, Lauren E.
Goldhaber-Fiebert, Jeremy D.
author_sort Cipriano, Lauren E.
collection PubMed
description The World Health Organization HCV Guideline Development Group is considering a “treat all” recommendation for persons infected with hepatitis C virus (HCV). We reviewed the model-based evidence of cost-effectiveness and population health impacts comparing expanded treatment policies to more limited treatment access policies, focusing primarily on evaluations of all-oral directly acting antivirals published after 2012. Searching PubMed, we identified 2,917 unique titles. Sequentially reviewing titles and abstracts identified 226 potentially relevant articles for full-text review. Sixty-nine articles met all inclusion criteria—42 cost-effectiveness analyses and 30 models of population-health impacts, with 3 articles presenting both types of analysis. Cost-effectiveness studies for many countries concluded that expanding treatment to people with mild liver fibrosis, who inject drugs (PWID), or who are incarcerated is generally cost-effective compared to more restrictive treatment access policies at country-specific prices. For certain patient subpopulations in some countries—for example, elderly individuals without fibrosis—treatment is only cost-effective at lower prices. A frequent limitation is the omission of benefits and consequences of HCV transmission (i.e., treatment as prevention; risks of reinfection), which may underestimate or overestimate the cost-effectiveness of a “treat all” policy. Epidemiologic modeling studies project that through a combination of prevention, aggressive screening and diagnosis, and prompt treatment for all fibrosis stages, it may be possible to virtually eliminate HCV in many countries. Studies show that if resources are not available to diagnose and treat all HCV-infected individuals, treatment prioritization may be needed, with alternative prioritization strategies resulting in tradeoffs between reducing mortality or reducing incidence. Notably, because most new HCV infections are among PWID in many settings, HCV elimination requires unrestricted treatment access combined with injection transmission disruption strategies. The model-based evidence suggests that a properly constructed strategy that substantially expands HCV treatment could achieve cost-effective improvements in population health in many countries.
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spelling pubmed-61574352018-10-04 Population Health and Cost-Effectiveness Implications of a “Treat All” Recommendation for HCV: A Review of the Model-Based Evidence Cipriano, Lauren E. Goldhaber-Fiebert, Jeremy D. MDM Policy Pract Review The World Health Organization HCV Guideline Development Group is considering a “treat all” recommendation for persons infected with hepatitis C virus (HCV). We reviewed the model-based evidence of cost-effectiveness and population health impacts comparing expanded treatment policies to more limited treatment access policies, focusing primarily on evaluations of all-oral directly acting antivirals published after 2012. Searching PubMed, we identified 2,917 unique titles. Sequentially reviewing titles and abstracts identified 226 potentially relevant articles for full-text review. Sixty-nine articles met all inclusion criteria—42 cost-effectiveness analyses and 30 models of population-health impacts, with 3 articles presenting both types of analysis. Cost-effectiveness studies for many countries concluded that expanding treatment to people with mild liver fibrosis, who inject drugs (PWID), or who are incarcerated is generally cost-effective compared to more restrictive treatment access policies at country-specific prices. For certain patient subpopulations in some countries—for example, elderly individuals without fibrosis—treatment is only cost-effective at lower prices. A frequent limitation is the omission of benefits and consequences of HCV transmission (i.e., treatment as prevention; risks of reinfection), which may underestimate or overestimate the cost-effectiveness of a “treat all” policy. Epidemiologic modeling studies project that through a combination of prevention, aggressive screening and diagnosis, and prompt treatment for all fibrosis stages, it may be possible to virtually eliminate HCV in many countries. Studies show that if resources are not available to diagnose and treat all HCV-infected individuals, treatment prioritization may be needed, with alternative prioritization strategies resulting in tradeoffs between reducing mortality or reducing incidence. Notably, because most new HCV infections are among PWID in many settings, HCV elimination requires unrestricted treatment access combined with injection transmission disruption strategies. The model-based evidence suggests that a properly constructed strategy that substantially expands HCV treatment could achieve cost-effective improvements in population health in many countries. SAGE Publications 2018-05-24 /pmc/articles/PMC6157435/ /pubmed/30288448 http://dx.doi.org/10.1177/2381468318776634 Text en © The Author(s) 2018 http://www.creativecommons.org/licenses/by-nc/4.0/ This article is distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 License (http://www.creativecommons.org/licenses/by-nc/4.0/) which permits non-commercial use, reproduction and distribution of the work without further permission provided the original work is attributed as specified on the SAGE and Open Access pages (https://us.sagepub.com/en-us/nam/open-access-at-sage).
spellingShingle Review
Cipriano, Lauren E.
Goldhaber-Fiebert, Jeremy D.
Population Health and Cost-Effectiveness Implications of a “Treat All” Recommendation for HCV: A Review of the Model-Based Evidence
title Population Health and Cost-Effectiveness Implications of a “Treat All” Recommendation for HCV: A Review of the Model-Based Evidence
title_full Population Health and Cost-Effectiveness Implications of a “Treat All” Recommendation for HCV: A Review of the Model-Based Evidence
title_fullStr Population Health and Cost-Effectiveness Implications of a “Treat All” Recommendation for HCV: A Review of the Model-Based Evidence
title_full_unstemmed Population Health and Cost-Effectiveness Implications of a “Treat All” Recommendation for HCV: A Review of the Model-Based Evidence
title_short Population Health and Cost-Effectiveness Implications of a “Treat All” Recommendation for HCV: A Review of the Model-Based Evidence
title_sort population health and cost-effectiveness implications of a “treat all” recommendation for hcv: a review of the model-based evidence
topic Review
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6157435/
https://www.ncbi.nlm.nih.gov/pubmed/30288448
http://dx.doi.org/10.1177/2381468318776634
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