Optimal control of hepatitis C antiviral treatment programme delivery for prevention amongst a population of injecting drug users.

In most developed countries, HCV is primarily transmitted by injecting drug users (IDUs). HCV antiviral treatment is effective, and deemed cost-effective for those with no re-infection risk. However, few active IDUs are currently treated. Previous modelling studies have shown antiviral treatment for...

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Autores principales:	Natasha K Martin, Ashley B Pitcher, Peter Vickerman, Anna Vassall, Matthew Hickman
Formato:	article
Lenguaje:	EN
Publicado:	Public Library of Science (PLoS) 2011
Materias:	Medicine R Science Q
Acceso en línea:	https://doaj.org/article/40296ed7e69147a3917713cf241fcd19
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spelling	oai:doaj.org-article:40296ed7e69147a3917713cf241fcd192021-11-18T06:48:13ZOptimal control of hepatitis C antiviral treatment programme delivery for prevention amongst a population of injecting drug users.1932-620310.1371/journal.pone.0022309https://doaj.org/article/40296ed7e69147a3917713cf241fcd192011-01-01T00:00:00Zhttps://www.ncbi.nlm.nih.gov/pmc/articles/pmid/21853030/pdf/?tool=EBIhttps://doaj.org/toc/1932-6203In most developed countries, HCV is primarily transmitted by injecting drug users (IDUs). HCV antiviral treatment is effective, and deemed cost-effective for those with no re-infection risk. However, few active IDUs are currently treated. Previous modelling studies have shown antiviral treatment for active IDUs could reduce HCV prevalence, and there is emerging interest in developing targeted IDU treatment programmes. However, the optimal timing and scale-up of treatment is unknown, given the real-world constraints commonly existing for health programmes. We explore how the optimal programme is affected by a variety of policy objectives, budget constraints, and prevalence settings. We develop a model of HCV transmission and treatment amongst active IDUs, determine the optimal treatment programme strategy over 10 years for two baseline chronic HCV prevalence scenarios (30% and 45%), a range of maximum annual budgets (£50,000-300,000 per 1,000 IDUs), and a variety of objectives: minimising health service costs and health utility losses; minimising prevalence at 10 years; minimising health service costs and health utility losses with a final time prevalence target; minimising health service costs with a final time prevalence target but neglecting health utility losses. The largest programme allowed for a given budget is the programme which minimises both prevalence at 10 years, and HCV health utility loss and heath service costs, with higher budgets resulting in greater cost-effectiveness (measured by cost per QALY gained compared to no treatment). However, if the objective is to achieve a 20% relative prevalence reduction at 10 years, while minimising both health service costs and losses in health utility, the optimal treatment strategy is an immediate expansion of coverage over 5-8 years, and is less cost-effective. By contrast, if the objective is only to minimise costs to the health service while attaining the 20% prevalence reduction, the programme is deferred until the final years of the decade, and is the least cost-effective of the scenarios.Natasha K MartinAshley B PitcherPeter VickermanAnna VassallMatthew HickmanPublic Library of Science (PLoS)articleMedicineRScienceQENPLoS ONE, Vol 6, Iss 8, p e22309 (2011)
institution	DOAJ
collection	DOAJ
language	EN
topic	Medicine R Science Q
spellingShingle	Medicine R Science Q Natasha K Martin Ashley B Pitcher Peter Vickerman Anna Vassall Matthew Hickman Optimal control of hepatitis C antiviral treatment programme delivery for prevention amongst a population of injecting drug users.
description	In most developed countries, HCV is primarily transmitted by injecting drug users (IDUs). HCV antiviral treatment is effective, and deemed cost-effective for those with no re-infection risk. However, few active IDUs are currently treated. Previous modelling studies have shown antiviral treatment for active IDUs could reduce HCV prevalence, and there is emerging interest in developing targeted IDU treatment programmes. However, the optimal timing and scale-up of treatment is unknown, given the real-world constraints commonly existing for health programmes. We explore how the optimal programme is affected by a variety of policy objectives, budget constraints, and prevalence settings. We develop a model of HCV transmission and treatment amongst active IDUs, determine the optimal treatment programme strategy over 10 years for two baseline chronic HCV prevalence scenarios (30% and 45%), a range of maximum annual budgets (£50,000-300,000 per 1,000 IDUs), and a variety of objectives: minimising health service costs and health utility losses; minimising prevalence at 10 years; minimising health service costs and health utility losses with a final time prevalence target; minimising health service costs with a final time prevalence target but neglecting health utility losses. The largest programme allowed for a given budget is the programme which minimises both prevalence at 10 years, and HCV health utility loss and heath service costs, with higher budgets resulting in greater cost-effectiveness (measured by cost per QALY gained compared to no treatment). However, if the objective is to achieve a 20% relative prevalence reduction at 10 years, while minimising both health service costs and losses in health utility, the optimal treatment strategy is an immediate expansion of coverage over 5-8 years, and is less cost-effective. By contrast, if the objective is only to minimise costs to the health service while attaining the 20% prevalence reduction, the programme is deferred until the final years of the decade, and is the least cost-effective of the scenarios.
format	article
author	Natasha K Martin Ashley B Pitcher Peter Vickerman Anna Vassall Matthew Hickman
author_facet	Natasha K Martin Ashley B Pitcher Peter Vickerman Anna Vassall Matthew Hickman
author_sort	Natasha K Martin
title	Optimal control of hepatitis C antiviral treatment programme delivery for prevention amongst a population of injecting drug users.
title_short	Optimal control of hepatitis C antiviral treatment programme delivery for prevention amongst a population of injecting drug users.
title_full	Optimal control of hepatitis C antiviral treatment programme delivery for prevention amongst a population of injecting drug users.
title_fullStr	Optimal control of hepatitis C antiviral treatment programme delivery for prevention amongst a population of injecting drug users.
title_full_unstemmed	Optimal control of hepatitis C antiviral treatment programme delivery for prevention amongst a population of injecting drug users.
title_sort	optimal control of hepatitis c antiviral treatment programme delivery for prevention amongst a population of injecting drug users.
publisher	Public Library of Science (PLoS)
publishDate	2011
url	https://doaj.org/article/40296ed7e69147a3917713cf241fcd19
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Optimal control of hepatitis C antiviral treatment programme delivery for prevention amongst a population of injecting drug users.

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