Mathematical Modeling of Hepatitis C Prevalence Reduction with Antiviral Treatment Scale-Up in Persons Who Inject Drugs in Metropolitan Chicago

PLoS One. 2015 Aug 21;10(8):e0135901. doi: 10.1371/journal.pone.0135901. eCollection 2015.

Abstract

Background/aim: New direct-acting antivirals (DAAs) provide an opportunity to combat hepatitis C virus (HCV) infection in persons who inject drugs (PWID). Here we use a mathematical model to predict the impact of a DAA-treatment scale-up on HCV prevalence among PWID and the estimated cost in metropolitan Chicago.

Methods: To estimate the HCV antibody and HCV-RNA (chronic infection) prevalence among the metropolitan Chicago PWID population, we used empirical data from three large epidemiological studies. Cost of DAAs is assumed $50,000 per person.

Results: Approximately 32,000 PWID reside in metropolitan Chicago with an estimated HCV-RNA prevalence of 47% or 15,040 cases. Approximately 22,000 PWID (69% of the total PWID population) attend harm reduction (HR) programs, such as syringe exchange programs, and have an estimated HCV-RNA prevalence of 30%. There are about 11,000 young PWID (<30 years old) with an estimated HCV-RNA prevalence of 10% (PWID in these two subpopulations overlap). The model suggests that the following treatment scale-up is needed to reduce the baseline HCV-RNA prevalence by one-half over 10 years of treatment [cost per year, min-max in millions]: 35 per 1,000 [$50-$77] in the overall PWID population, 19 per 1,000 [$20-$26] for persons in HR programs, and 5 per 1,000 [$3-$4] for young PWID.

Conclusions: Treatment scale-up could dramatically reduce the prevalence of chronic HCV infection among PWID in Chicago, who are the main reservoir for on-going HCV transmission. Focusing treatment on PWID attending HR programs and/or young PWID could have a significant impact on HCV prevalence in these subpopulations at an attainable cost.

Publication types

  • Research Support, N.I.H., Extramural
  • Research Support, U.S. Gov't, Non-P.H.S.

MeSH terms

  • Adult
  • Age Factors
  • Antiviral Agents / economics
  • Antiviral Agents / therapeutic use*
  • Chicago / epidemiology
  • Cost-Benefit Analysis
  • Harm Reduction / ethics
  • Hepatitis C Antibodies / blood
  • Hepatitis C, Chronic / complications
  • Hepatitis C, Chronic / drug therapy*
  • Hepatitis C, Chronic / economics
  • Hepatitis C, Chronic / epidemiology
  • Humans
  • Middle Aged
  • Models, Statistical*
  • Prevalence
  • RNA, Viral / antagonists & inhibitors*
  • RNA, Viral / blood
  • Substance Abuse, Intravenous / complications
  • Substance Abuse, Intravenous / drug therapy*
  • Substance Abuse, Intravenous / economics
  • Substance Abuse, Intravenous / epidemiology

Substances

  • Antiviral Agents
  • Hepatitis C Antibodies
  • RNA, Viral