title: Treatment scale-up to achieve global HCV incidence and mortality elimination targets: a cost-effectiveness model.
abstract: The WHO's draft HCV elimination targets propose an 80% reduction in incidence and a 65% reduction in HCV-related deaths by 2030. We estimate the treatment scale-up required and cost-effectiveness of reaching these targets among injecting drug use (IDU)-acquired infections using Australian disease estimates.
  
  
  
  A mathematical model of HCV transmission, liver disease progression and treatment among current and former people who inject drugs (PWID). Treatment scale-up and the most efficient allocation to priority groups (PWID or patients with advanced liver disease) were determined; total healthcare and treatment costs, quality-adjusted life years (QALYs) and incremental cost-effectiveness ratios (ICERs) compared with inaction were calculated.
  
  
  
  5662 (95% CI 5202 to 6901) courses per year (30/1000 IDU-acquired infections) were required, prioritised to patients with advanced liver disease, to reach the mortality target. 4725 (3278-8420) courses per year (59/1000 PWID) were required, prioritised to PWID, to reach the incidence target; this also achieved the mortality target, but to avoid clinically unacceptable HCV-related deaths an additional 5564 (1959-6917) treatments per year (30/1000 IDU-acquired infections) were required for 5 years for patients with advanced liver disease. Achieving both targets in this way cost $A4.6 ($A4.2-$A4.9) billion more than inaction, but gained 184 000 (119 000-417 000) QALYs, giving an ICER of $A25 121 ($A11 062-$A39 036) per QALY gained.
  
  
  
  Achieving WHO elimination targets with treatment scale-up is likely to be cost-effective, based on Australian HCV burden and demographics. Reducing incidence should be a priority to achieve both WHO elimination goals in the long-term.
authors.affiliation: Centre for Population Health, Burnet Institute, Melbourne, Victoria, Australia.|Department of Epidemiology and Preventive Medicine, Monash University, Clayton, Victoria, Australia.
authors.forename: Nick
authors.initials: N
authors.lastname: Scott
authors.affiliation: Centre for Population Health, Burnet Institute, Melbourne, Victoria, Australia.|Australian Institute of Tropical Health and Medicine, James Cook University, Townsville, Queensland, Australia.|Department of Medicine, The University of Melbourne, Parkville, Victoria, Australia.
authors.forename: Emma S
authors.initials: ES
authors.lastname: McBryde
authors.affiliation: Department of Medicine, The University of Melbourne, Parkville, Victoria, Australia.|Department of Gastroenterology, St Vincent's Hospital Melbourne, Melbourne, Victoria, Australia.
authors.forename: Alexander
authors.initials: A
authors.lastname: Thompson
authors.affiliation: Centre for Population Health, Burnet Institute, Melbourne, Victoria, Australia.|Department of Gastroenterology, St Vincent's Hospital Melbourne, Melbourne, Victoria, Australia.|Victorian Infectious Diseases Service at the Doherty Institute, Melbourne Health, Melbourne, Victoria, Australia.
authors.forename: Joseph S
authors.initials: JS
authors.lastname: Doyle
authors.affiliation: Centre for Population Health, Burnet Institute, Melbourne, Victoria, Australia.|Department of Epidemiology and Preventive Medicine, Monash University, Clayton, Victoria, Australia.|Department of Infectious Diseases, Alfred Hospital, Melbourne, Victoria, Australia.
authors.forename: Margaret E
authors.initials: ME
authors.lastname: Hellard
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001315:Australia / Q000453:epidemiology; D003362:Cost-Benefit Analysis; D014943:Global Health; D006040:Goals; D040261:Harm Reduction; D017048:Health Care Costs / Q000706:statistics & numerical data*; D006526:Hepatitis C / Q000188:drug therapy / Q000191:economics* / Q000453:epidemiology* / Q000517:prevention & control; D006801:Humans; D015994:Incidence; D008875:Middle Aged; D018803:Models, Economic; D015995:Prevalence; D019057:Quality-Adjusted Life Years; D015819:Substance Abuse, Intravenous / Q000453:epidemiology*; D014944:World Health Organization; D055815:Young Adult
keywords: COST-EFFECTIVENESS; EPIDEMIOLOGY; HEPATITIS C