The impact of direct acting antivirals on hepatitis C virus disease burden and associated costs in four European countries

Background and Aims: We assessed the clinical and economic impact of direct-acting antiviral (DAA) therapy for hepatitis C virus (HCV) in England, Italy, Romania and Spain. Methods: An HCV progression Markov model was developed considering DAA eligibility and population data during the years 2015-2019. The period of time to recover the investment in DAAs was calculated as the cost saved by avoiding estimated clinical events for 1000 standardized treated patients. A delayed treatment scenario because of coronavirus disease (COVID-19) was also developed. Results: The estimated number of avoided hepatocellular carcinoma, decompensated cirrhosis and liver transplantations over a 20-year time horizon was: 1,057 in England; 1,221 in Italy; 1,211 in Romania; and 1,103 in Spain for patients treated during 2015-2016 and 640 in England; 626 in Italy; 739 in Romania; and 643 in Spain for patients treated during 2017-2019. The cost-savings ranged from \u20ac 45 to \u20ac 275 million. The investment needed to expand access to DAAs in 2015-2019 is estimated to be recovered in 6.5 years in England; 5.4 years in Italy; 6.7 years in Romania; and 4.5 years in Spain. A delay in treatment because of COVID-19 will increase liver mortality in all countries. Conclusion: Direct-acting antivirals have significant clinical benefits and can bring substantial cost-savings over the next 20 years, reaching a Break-even point in a short period of time. When pursuing an exit strategy from strict lockdown measures for COVID-19, providing DAAs should remain high on the list of priorities in order to maintain HCV elimination efforts

Hepatitis C virus prevalence and level of intervention required to achieve the WHO targets for elimination in the European Union by 2030 : a modelling study

Background Hepatitis C virus (HCV) is a leading cause of liver-related morbidity and mortality worldwide. In the European Union (EU), treatment and cure of HCV with direct-acting antiviral therapies began in 2014. WHO targets are to achieve a 65% reduction in liver-related deaths, a 90% reduction of new viral hepatitis infections, and 90% of patients with viral hepatitis infections being diagnosed by 2030. This study assessed the prevalence of HCV in the EU and the level of intervention required to achieve WHO targets for HCV elimination. Methods We populated country Markov models for the 28 EU countries through a literature search of PubMed and Embase between Jan 1, 2000, and March 31, 2016, and a Delphi process to gain expert consensus and validate inputs. We aggregated country models to create a regional EU model. We used the EU model to forecast HCV disease progression (considering the effect of immigration) and developed a strategy to acehive WHO targets. We used weighted average sustained viral response rates and fibrosis restrictions to model the effect of current therapeutic guidelines. We used the EU model to forecast HCV disease progression (considering the effect of immigration) under current screening and therapeutic guidelines. Additionally, we back-calculated the total number of patients needing to be screened and treated to achieve WHO targets. Findings We estimated the number of viraemic HCV infections in 2015 to be 3\ue2\u80\u88238\ue2\u80\u88000 (95% uncertainty interval [UI] 2\ue2\u80\u88106\ue2\u80\u88000\ue2\u80\u933\ue2\u80\u88795\ue2\u80\u88000) of a total population of 509\ue2\u80\u88868\ue2\u80\u88000 in the EU, equating to a prevalence of viraemic HCV of 0\uc2\ub764% (95% UI 0\uc2\ub741\ue2\u80\u930\uc2\ub774). We estimated that 1\ue2\u80\u88180\ue2\u80\u88000 (95% UI 1\ue2\u80\u88003\ue2\u80\u88000\ue2\u80\u931\ue2\u80\u88357\ue2\u80\u88000) people were diagnosed with viraemia (36\uc2\ub74%), 150\ue2\u80\u88000 (12\ue2\u80\u88000\ue2\u80\u93180\ue2\u80\u88000) were treated (4\uc2\ub76% of the total infected population or 12\uc2\ub77% of the diagnosed population), 133\ue2\u80\u88000 (106\ue2\u80\u88000\ue2\u80\u93160\ue2\u80\u88000) were cured (4\uc2\ub71%), and 57\ue2\u80\u88900 (43\ue2\u80\u88900\ue2\u80\u9367\ue2\u80\u88300) were newly infected (1\uc2\ub78%) in 2015. Additionally, 30\ue2\u80\u88400 (26\ue2\u80\u88600\ue2\u80\u9342\ue2\u80\u88500) HCV-positive immigrants entered the EU. To achieve WHO targets, unrestricted treatment needs to increase from 150\ue2\u80\u88000 patients in 2015 to 187\ue2\u80\u88000 patients in 2025 and diagnosis needs to increase from 88\ue2\u80\u88800 new cases annually in 2015 to 180\ue2\u80\u88000 in 2025. Interpretation Given its advanced health-care infrastructure, the EU is uniquely poised to eliminate HCV; however, expansion of screening programmes is essential to increase treatment to achieve the WHO targets. A united effort, grounded in sound epidemiological evidence, will also be necessary. Funding Gilead Sciences

The global NAFLD policy review and preparedness index: Are countries ready to address this silent public health challenge?

Background & aims: Non-alcoholic fatty liver disease (NAFLD) is a highly prevalent, yet largely underappreciated liver condition which is closely associated with obesity and metabolic disease. Despite affecting an estimated 1 in 4 adults globally, NAFLD is largely absent on national and global health agendas. Methods: We collected data from 102 countries, accounting for 86% of the world population, on NAFLD policies, guidelines, civil society engagement, clinical management, and epidemiologic data. A preparedness index was developed by coding questions into 6 domains (policies, guidelines, civil awareness, epidemiology and data, NAFLD detection, and NAFLD care management) and categorising the responses as high, medium, and low; a multiple correspondence analysis was then applied. Results: The highest scoring countries were India (42.7) and the United Kingdom (40.0), with 32 countries (31%) scoring zero out of 100. For 5 of the domains a minority of countries were categorised as high-level while the majority were categorised as low-level. No country had a national or sub-national strategy for NAFLD and <2% of the different strategies for related conditions included any mention of NAFLD. National NAFLD clinical guidelines were present in only 32 countries. Conclusions: Although NAFLD is a pressing public health problem, no country was found to be well prepared to address it. There is a pressing need for strategies to address NAFLD at national and global levels. Lay summary: Around a third of the countries scored a zero on the NAFLD policy preparedness index, with no country scoring over 50/100. Although NAFLD is a pressing public health problem, a comprehensive public health response is lacking in all 102 countries. Policies and strategies to address NAFLD at the national and global levels are urgently needed