Allocating treatment resources for hepatitis C in the UK: a constrained optimization modelling approach

Figures & data

Figures 1. The core Markov model structure

Table 1. Main difference in Markov inputs for PWID, MSM and the general population

	The general population	PWID	MSM
Baseline mortality	UK life table	An increased mortality of 0.01 due to overdose [64]	UK life table
Disease transition	NICE model [103]	The same as the NICE model based on a meta-analysis [5]	The same as the NICE model based on a meta-analysis [5]
Efficacy and safety of DAAs	NICE NMA [108]	The same as NICE NMA based on a meta-analysis [66]	The same as NICE NMA based on a meta-analysis [109]
Reinfection after SVR	1.0% [63]	2.1% [65,66]	3.5% [15,71,72]
Costs	The product of unit costs* and resource uses [103]	The same unit costs	The same unit costs
Utility	UK mild CHC trial [103]	An adjustment of 0.8 for HRQoL [69]	An assumed adjustment of 0.9 based on [70,73–75]

*Unit costs include annual treatment costs of different health states, daily drug costs, treatment monitoring costs per treatment course and treatment costs of drug-related adverse events per event.

CHC: chronic hepatitis C; DAAs: direct acting antivirals; EG: elbasvir-grazoprevir; HRQoL: health-related quality of life; MSM: men who have sex with men; NMA: network-meta-analyses; NICE: National Institute for Health and Care Excellence; OBV/PTV/r: ombitasvir-paritaprevir-ritonavir-dasabuvi; PWID: people who inject drugs; SOF/LED: sofosbuvir-ledipasvir; SVR: sustained viral response

Table 2. Parameters derived from the core Markov model

	The general population	PWID	MSM
Total lifetime treatment costs
OBV/PTV/r	£44,991	£45,483	£50,396
EBR/GRZ	£48,272	£48,660	£53,587
SOF/LED	£50,321	£50,815	£55,736
PR	£66,613	£63,852	£68,718
No treatment	£32,769	£27,850	£32,769
Liver-related death rates
OBV/PTV/r	18.38%	15.96%	19.27%
EBR/GRZ	18.31%	15.89%	19.22%
SOF/LED	18.28%	15.88%	19.20%
PR	21.73%	18.37%	21.92%
No treatment	22.98%	19.16%	22.98%

DAAs: direct acting antivirals; EBR/GRZ: elbasvir-grazoprevir; MSM: men who have sex with men; OBV/PTV/r: ombitasvir-paritaprevir-ritonavir-dasabuvi; PR: pegylated interferon-ribavirin; PWID: people who inject drugs; SOF/LED: sofosbuvir-ledipasvir

Table 3. Optimal allocation of treatment resources for CHC in the base case

						Decision variables (Number of patients receiving treatment)										Objective function (Minimum number of liver-related death)
	The general population							PWID				MSM
	OBV /PTV/r		EBR/ GRZ		SOF/ LED		PR	OBV/ PTV/r	EBR/ GRZ	SOF/ LED	PR	OBV/ PTV/r	EBR/ GRZ	SOF/ LED	PR
Current allocation	1,223		718		1,056		447	2,909	1,708	2,513	1,064	42	25	36	15	30,730
Optimal allocation	904		0		0		0	13,122	0	0	0	160	0	0	0	30,651

EBR/GRZ: elbasvir-grazoprevir; MSM: men who have sex with men; OBV/PTV/r: ombitasvir-paritaprevir-ritonavir-dasabuvi; PR: pegylated interferon-ribavirin; PWID: people who inject drugs; SOF/LED: sofosbuvir-ledipasvir

Table 4. Optimal allocation in the scenario of ICER-based analysis

						Decision variables (Number of patients receiving treatment)																Objective function (Maximum number of QALYs gained)
	The general population							PWID									MSM
	OBV/ PTV/r	EBR/ GRZ		SOF/ LED		PR			OBV/ PTV/r		EBR/ GRZ		SOF/LED		PR			OBV/PTV/r	EBR/GRZ	SOF/LED	PR
Current allocation	1,223		718		1,056		447			2,909		1,708		2,513		1,064		42	25	36	15	1,307,779
Base case optimal allocation	904		0		0		0			13,122		0		0		0		160	0	0	0	1,309,666
Scenario case optimal allocation	20,066		0		0		0			0		0		0		0		0	0	0	0	1,326,969
ICER versus no treatment	£7,945		£10,220		£11,371		£72,410			£19,282		£23,080		£25,029		£155,730		£16,197	£19,400	£21,032	£121,343	-

EBR/GRZ: elbasvir-grazoprevir; ICER: incremental cost-effectiveness ratio; MSM: men who have sex with men; OBV/PTV/r: ombitasvir-paritaprevir-ritonavir-dasabuvi; PR: pegylated interferon-ribavirin; PWID: people who inject drugs; QALYs: quality-adjusted life-years; SOF/LED: sofosbuvir-ledipasvir

Table 5. Optimal allocation to reach APPG target

						Decision variables (Number of patients receiving treatment)										Objective function (Minimum additional funding required)
	The general population							PWID				MSM
	OBV/ PTV/r		EBR/ GRZ		SOF/ LED		PR	OBV/ PTV/r	EBR/ GRZ	SOF/ LED	PR	OBV/ PTV/r	EBR/ GRZ	SOF/ LED	PR
Current allocation	1,223		718		1,056		447	2,909	1,708	2,513	1,064	42	25	36	15	£4,760,341,962
Base case optimal allocation	904		0		0		0	13,122	0	0	0	160	0	0	0	£4,760,341,962
Scenario case optimal allocation	1,275		0		0		0	18,500	0	0	0	225	0	0	0	£4,860,854,545

EBR/GRZ: elbasvir-grazoprevir; MSM: men who have sex with men; OBV/PTV/r: ombitasvir-paritaprevir-ritonavir-dasabuvi; PR: pegylated interferon-ribavirin; PWID: people who inject drugs; SOF/LED: sofosbuvir-ledipasvir

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Data availability statement

The data relating to the model parameters are all included in the article and/or its supplementary materials. The model used in the study can be made available to researchers upon request.