title: Mathematical Modeling of Hepatitis C Prevalence Reduction with Antiviral Treatment Scale-Up in Persons Who Inject Drugs in Metropolitan Chicago.
abstract: OBJECTIVE
  New direct-acting antivirals (DAAs) provide an opportunity to combat hepatitis C virus (HCV) infection in persons who inject drugs (PWID). Here we use a mathematical model to predict the impact of a DAA-treatment scale-up on HCV prevalence among PWID and the estimated cost in metropolitan Chicago.
  
  
  METHODS
  To estimate the HCV antibody and HCV-RNA (chronic infection) prevalence among the metropolitan Chicago PWID population, we used empirical data from three large epidemiological studies. Cost of DAAs is assumed $50,000 per person.
  
  
  RESULTS
  Approximately 32,000 PWID reside in metropolitan Chicago with an estimated HCV-RNA prevalence of 47% or 15,040 cases. Approximately 22,000 PWID (69% of the total PWID population) attend harm reduction (HR) programs, such as syringe exchange programs, and have an estimated HCV-RNA prevalence of 30%. There are about 11,000 young PWID (<30 years old) with an estimated HCV-RNA prevalence of 10% (PWID in these two subpopulations overlap). The model suggests that the following treatment scale-up is needed to reduce the baseline HCV-RNA prevalence by one-half over 10 years of treatment [cost per year, min-max in millions]: 35 per 1,000 [$50-$77] in the overall PWID population, 19 per 1,000 [$20-$26] for persons in HR programs, and 5 per 1,000 [$3-$4] for young PWID.
  
  
  CONCLUSIONS
  Treatment scale-up could dramatically reduce the prevalence of chronic HCV infection among PWID in Chicago, who are the main reservoir for on-going HCV transmission. Focusing treatment on PWID attending HR programs and/or young PWID could have a significant impact on HCV prevalence in these subpopulations at an attainable cost.
authors: The Program for Experimental & Theoretical Modeling, Division of Hepatology, Department of Medicine, Loyola University Chicago, Medical Center, Maywood, Illinois, United States of America.
authors: Desarae
authors: D
authors: Echevarria
authors: The Program for Experimental & Theoretical Modeling, Division of Hepatology, Department of Medicine, Loyola University Chicago, Medical Center, Maywood, Illinois, United States of America; Division of Epidemiology and Biostatistics, School of Public Health, University of Illinois at Chicago, Chicago, Illinois, United States of America.
authors: Alexander
authors: A
authors: Gutfraind
authors: Division of Epidemiology and Biostatistics, School of Public Health, University of Illinois at Chicago, Chicago, Illinois, United States of America.
authors: Basmattee
authors: B
authors: Boodram
authors: Division of Viral Products, Center for Biologics Evaluation and Research, Food and Drug Administration, Silver Spring, Maryland, United States of America.
authors: Marian
authors: M
authors: Major
authors: Energy and Infrastructure Analysis Group, Los Alamos National Laboratory, Los Alamos, New Mexico, United States of America.
authors: Sara
authors: S
authors: Del Valle
authors: The Program for Experimental & Theoretical Modeling, Division of Hepatology, Department of Medicine, Loyola University Chicago, Medical Center, Maywood, Illinois, United States of America.
authors: Scott J
authors: SJ
authors: Cotler
authors: The Program for Experimental & Theoretical Modeling, Division of Hepatology, Department of Medicine, Loyola University Chicago, Medical Center, Maywood, Illinois, United States of America; Theoretical and Biophysics Group, Los Alamos National Laboratory, Los Alamos, New Mexico, United States of America.
authors: Harel
authors: H
authors: Dahari
mesh_terms: D000328:Adult; D000367:Age Factors; D000998:Antiviral Agents / Q000191:economics / Q000627:therapeutic use*; D002641:Chicago / Q000453:epidemiology; D003362:Cost-Benefit Analysis; D040261:Harm Reduction / Q000941:ethics; D018937:Hepatitis C Antibodies / Q000097:blood; D019698:Hepatitis C, Chronic / Q000150:complications / Q000188:drug therapy* / Q000191:economics / Q000453:epidemiology; D006801:Humans; D008875:Middle Aged; D015233:Models, Statistical; D015995:Prevalence; D012367:RNA, Viral / Q000037:antagonists & inhibitors* / Q000097:blood; D015819:Substance Abuse, Intravenous / Q000150:complications / Q000188:drug therapy* / Q000191:economics / Q000453:epidemiology
chemical_list: D000998:Antiviral Agents; D018937:Hepatitis C Antibodies; D012367:RNA, Viral