Background

Increasing number of hepatitis C virus (HCV) infections among HIV positive men whohave sex with men (MSM) as in an acute HIV infection cohort study in Bangkok, reached an incidence of 45/1000 person-years in 2018. Direct-acting antivirals (DAAs), that cure HCV infection and thereby can prevent transmission, are expensive, their reimbursement being presently delayed to the chronic stages of liver fibrosis. The aim of this study was to determine the cost-effectiveness of immediate DAA treatment to reduce HCV transmission among HIV positive MSM in Bangkok.

Methods

A deterministic transmission model was calibrated to the HCV epidemic among HIV positive MSM in Bangkok. We compared the current practice of starting DAAs at METAVIR stage F2 rather than at stage F1, or immediately after diagnosis, at stage F0. Cost-effectiveness was examined from a payer's perspective, using a 3% annual discounting rate.

Results

Compared to the incidence in 2018, delaying DAA treatment to METAVIR stage F2 or F1, increases HCV incidence in 2030 to 63/1000 person-years and 56/1000 person-years, respectively. Conversely, immediate DAA treatment reduces the incidence to 26/1000 person-years. Compared to initiating treatment at stage F2, immediate treatment is cost saving within seven years and saves $17 million over 40 years. One-way sensitivity analysis showed that lower cost savings were achieved at a higher price of DAA treatment and at less frequent HCV screening.

Conclusion

Immediate DAA treatment is cost saving and increases health benefits by reducing HCV incidence among HIV-infected MSM.

中文翻译：

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扩大使用直接作用抗病毒药物的立即治疗报销，以降低泰国曼谷男男性行为艾滋病毒阳性男性的丙型肝炎发病率：一项成本效益模型研究

背景

根据曼谷的一项急性 HIV 感染队列研究，2018 年，男男性行为者 (MSM) 的 HIV 阳性男性中丙型肝炎病毒 (HCV) 感染人数不断增加，发病率达到 45/1000 人年。直接作用抗病毒药物（ DAA）能够治愈丙型肝炎病毒感染，从而预防传播，但价格昂贵，其报销目前被推迟到肝纤维化的慢性阶段。本研究的目的是确定立即进行 DAA 治疗以减少曼谷 HIV 阳性 MSM 中 HCV 传播的成本效益。

方法

根据曼谷 HIV 阳性 MSM 中的 HCV 流行情况，对确定性传播模型进行了校准。我们比较了目前在 METAVIR F2 期开始 DAA 的做法，而不是在 F1 期或诊断后立即在 F0 期开始 DAA。使用 3% 的年度折扣率从付款人的角度审查成本效益。

结果

与2018年的发病率相比，将DAA治疗延迟至METAVIR F2或F1期，会使2030年的HCV发病率分别增加至63/1000人年和56/1000人年。相反，立即 DAA 治疗可将发病率降低至 26/1000 人年。与 F2 阶段开始治疗相比，立即治疗可在 7 年内节省成本，并在 40 年内节省 1700 万美元。单向敏感性分析表明，较高的 DAA 治疗价格和较低的 HCV 筛查频率可以实现较低的成本节省。

结论

立即 DAA 治疗可降低感染 HIV 的 MSM 中的 HCV 发病率，从而节省成本并增加健康效益。