The impact and cost-effectiveness of scaling up HCV treatment for achieving elimination among people who inject drugs in England: a synopsis including evidence synthesis and economic modelling

Background People who inject drugs are disproportionately affected by hepatitis C virus. The emergence of direct-acting antiviral treatments for hepatitis C virus motivated England to achieve the World Health Organization’s elimination target of decreasing hepatitis C virus incidence among people who inject drugs to 80% probability in three regions and 40% probability in the other region. The probability of reaching the incidence target increases to > 65% in this region if screening is increased in drug treatment centres (80% screened annually) or prisons (75% of people get tested during their prison stay), with these screening strategies being cost-effective. Conclusion Numerous England regions may be on target to decrease hepatitis C virus incidence among people who inject drugs to < 2/100 person-years. In regions that are not on target, further scale-up of testing in drug treatment centre or prison from 2024 could enable them to reach the World Health Organization elimination target and be cost-effective. Limitations Projections were based on model estimations, which need to be confirmed with empirical data. Data uncertainties affected our model projections, including uncertainty in the number of people who inject drugs in each region and the number of treatments given to people who inject drugs in different settings. Sample sizes for the yearly bio-behavioural surveys among people who inject drugs were small, and so samples were pooled over multiple years. Testing rates among people who inject drugs could not be directly estimated because the sentinel surveillance had incomplete coverage and could not identify people who inject drugs; testing rates were estimated through model calibration. Future work There is interest in understanding what scale-back in testing can occur after 2030 without resulting in a rebound in hepatitis C virus incidence, and in developing models for each devolved nation to determine their progress to World Health Organization hepatitis C virus elimination targets. Funding This synopsis presents independent research funded by the National Institute for Health and Care Research (NIHR) Health Technology Assessment programme as award number NIHR128513.