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Lookup NU author(s): Professor Stuart McPhersonORCiD
This work is licensed under a Creative Commons Attribution 4.0 International License (CC BY 4.0).
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 < 2 per 100 person-years (/100 person-years) by 2030. We determined whether existing testing and treatment strategies will reach this target in England, or whether improved strategies are needed and whether they are cost-effective. Methods: A dynamic hepatitis C virus transmission model among people who inject drugs was developed for four English regions. The model included the pathway from testing to treatment in prisons, drug treatment centres and other settings. Each pathway was parameterised using region-specific data, with yearly bio-behavioural surveys among people who inject drugs being used to parameterise and calibrate the model in a Bayesian framework. The model projected whether each region will reach the hepatitis C virus incidence target or what improvements (in testing and linkage to treatment) are needed from 2024 to achieve it. Hepatitis C virus care pathway costs were collated through interviews with practitioners and the published literature. The mean incremental cost-effectiveness ratio (per quality-adjusted life-year saved) was estimated for any 'improved' strategy that reached the incidence target compared to the baseline strategy. Incremental cost-effectiveness ratios were compared to a willingness-to-pay threshold of £20,000/quality-adjusted life-year saved over a 50-year time horizon (3.5% annual discount rate). Results: Across the four regions over 2016-22, an estimated 8831-9689 treatments occurred among 37,230 people who inject drugs, with the annual number treated increasing in prisons (7.8 times) and drug treatment centres (3.6 times). Model projections suggest that hepatitis C virus incidence among people who inject drugs has decreased across the regions by 56.1-85.4% (range of medians) over 2015-22, with incidence decreasing by 79.7-98.6% to 0.2-2.2/100 person-years by 2030. The World Health Organization incidence target (< 2/100 person-years) will be reached with > 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.Hepatitis C virus infection is a common cause of liver disease in England, with about 92,900 people infected. In the United Kingdom, most new hepatitis C virus infections result from injecting drug use. New treatments for hepatitis C virus can cure nearly all patients. The World Health Organization set targets for reducing the number of new hepatitis C virus infections among people who inject drugs by 2030. For England to meet these targets, the number of people who inject drugs that receive hepatitis C virus treatment needed to increase. New approaches to diagnose and refer people who inject drugs to treatment (called hepatitis C virus case-finding interventions) have been scaled up. These focus on locations where people who inject drugs can be tested, like prison and drug treatment services. We wanted to find out whether these new approaches have increased treatment enough to achieve the target for reducing new infections. If they have not, we wanted to find the cheapest way to improve hepatitis C virus case-finding to reach these targets. We developed a model that estimates how hepatitis C virus spreads among people who inject drugs in four English regions. We used this model to decide whether new approaches to improve hepatitis C virus case-finding will achieve the World Health Organization target in each region. If they will not, the model for each region was used to decide how to improve hepatitis C virus case-finding to reach the target. Managers of services and patients suggested how case-finding could be improved. We compared the healthcare costs and reduction in new hepatitis C virus infections to see if they were worthwhile improvements. We found that the new approaches to improve hepatitis C virus case-finding decreased the number of new hepatitis C virus infections enough in three English regions, but in the other region, more testing is needed in prisons or drug treatment services. The cost of this strategy was worthwhile, considering the number of new infections prevented. Many regions in England may be on target to reach the World Health Organization targets for decreasing new infections of hepatitis C virus. However, in some regions, more testing may be needed in prisons or drug treatment services to reach these World Health Organization targets. The cost of this is worthwhile because it is partially offset by reduced costs from fewer new infections.
Author(s): Ward Z, Simmons R, Fraser H, Trickey A, Kesten J, Gibson A, Reid L, Cox S, Gordon F, McPherson S, Ryder S, Vilar FJ, Miners A, Williams J, Emmanouil B, Desai M, Coughlan L, Harris R, Foster GR, Hickman M, Mandal S, Vickerman P
Publication type: Article
Publication status: Published
Journal: Health Technology Assessment
Year: 2026
Volume: 30
Issue: 7
Pages: 1-14
Online publication date: 01/01/2026
Acceptance date: 31/07/2025
Date deposited: 16/02/2026
ISSN (print): 1366-5278
ISSN (electronic): 2046-4924
Publisher: NIHR Journals Library
URL: https://doi.org/10.3310/GJPV1707
DOI: 10.3310/GJPV1707
PubMed id: 41631640
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