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Treatment scale-up to achieve global HCV incidence and mortality elimination targets: a cost-effectiveness model
  1. Nick Scott1,2,
  2. Emma S McBryde1,3,4,
  3. Alexander Thompson4,5,
  4. Joseph S Doyle1,5,6,
  5. Margaret E Hellard1,2,7
  1. 1 Centre for Population Health, Burnet Institute, Melbourne, Victoria, Australia
  2. 2 Department of Epidemiology and Preventive Medicine, Monash University, Clayton, Victoria, Australia
  3. 3 Australian Institute of Tropical Health and Medicine, James Cook University, Townsville, Queensland, Australia
  4. 4 Department of Medicine, The University of Melbourne, Parkville, Victoria, Australia
  5. 5 Department of Gastroenterology, St Vincent's Hospital Melbourne, Melbourne, Victoria, Australia
  6. 6 Victorian Infectious Diseases Service at the Doherty Institute, Melbourne Health, Melbourne, Victoria, Australia
  7. 7 Department of Infectious Diseases, Alfred Hospital, Melbourne, Victoria, Australia
  1. Correspondence to Dr Nick Scott, Centre for Population Health, Burnet Institute, 85 Commercial Rd, Melbourne, VIC 3004, Australia; Nick.Scott{at}


Aims 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.

Methods 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.

Results 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.

Conclusions 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.


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