title: Have we significantly underestimated the capacity in the Australian health system to treat chronic hepatitis C infection in an interferon-free era?
abstract: BACKGROUND
  New antiviral therapies for hepatitis C infection may lead to an increase in capacity to treat because of their simplicity and safety.
  
  
  OBJECTIVE
  To determine the likely current capacity of accredited treatment centres in treating hepatitis C (HCV) patients with interferon (IFN)-free direct acting antiviral (DAA) agents in Australia.
  
  
  METHODS
  Data were collected from 22 centres before the introduction of DAA therapy - 11 sites from the Study 1 survey and an additional 11 sites from the Study 2 survey. The sites were selected based on consensus by viral hepatitis experts, in consultation with the NSW Agency for Clinical Innovation. The services were selected as they were experienced in the delivery of IFN-based treatments and/or had knowledge about IFN-free regimens. The sites selected offered a mix of metropolitan and regional clinics, opioid substitution clinics, Aboriginal services, general practitioner-initiated, criminal justice and nurse-led services. Following the survey, the first 3 months of actual treatment uptake, since listing in March and May 2016, became available for a comparison and were subsequently analysed.
  
  
  RESULTS
  The survey indicated that an average of 27 h would be required to treat patients with IFN-based regimens. This was reduced to an average of 9 h if IFN-free regimens were used. The average number of patients on IFN-based treatment regimens per site was 87 per year compared to 493 per site if IFN-free therapy was freely available. There is capacity in the current health system to treat five times the numbers of patients with chronic HCV in Australia. When applying a weighted ratio; the results for all centres show a 3.6-fold increase in the capacity to treat with IFN-free regimens. However, these numbers may be an underestimate based on the first 3 months of actual treatment uptake since Pharmaceutical Benefits Scheme listing in March and May 2016.
  
  
  CONCLUSIONS
  Although current sites have a significant capacity to increase rapidly HCV treatment numbers, expansion of treatment settings and new models of care and training may be required to deliver HCV treatment to all HCV-infected individuals.
authors.affiliation: NSW Agency for Clinical Innovation, Sydney, New South Wales, Australia.
authors.forename: I A
authors.initials: IA
authors.lastname: Kaan
authors.affiliation: Department of Gastroenterology, John Hunter Hospital, Newcastle, New South Wales, Australia.
authors.forename: T
authors.initials: T
authors.lastname: Jones
authors.affiliation: AW Morrow Gastroenterology and Liver Centre, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia.|Centenary Institute, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia.|University of Sydney, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia.
authors.forename: G W
authors.initials: GW
authors.lastname: McCaughan
mesh_terms: D000998:Antiviral Agents / Q000191:economics / Q000627:therapeutic use*; D001315:Australia; D003362:Cost-Benefit Analysis; D003695:Delivery of Health Care / Q000458:organization & administration* / Q000706:statistics & numerical data; D004359:Drug Therapy, Combination; D016174:Hepacivirus / Q000187:drug effects*; D019698:Hepatitis C, Chronic / Q000188:drug therapy* / Q000453:epidemiology; D006801:Humans; D016896:Treatment Outcome
chemical_list: D000998:Antiviral Agents
keywords: clinical treatment capacity; cost benefit analysis; hepatitis C; integrated care; models of care