HCV in Norway: multipronged approach needed to reach WHO goals

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Takeaway

  • Multipronged approaches are cost-effective for improving HCV treatment uptake and reducing new infections among Norwegian people who inject drugs (PWID).
  • Combination strategies are needed to achieve WHO eradication goals for 2020.

Why this matters

  • In 2016, the treatment policies in Norway limited use of direct-acting antivirals (DAAs) to patients with moderate or advanced fibrosis.
  • Current coverage for opioid substitution therapy (OST) and needle and syringe programs (NSP) remains suboptimal.

Study design

  • Compartmental Markov model was used to analyze the effect of screening initiatives (screening at specialized vs general practitioner [GP] clinics) and targeted interventions (scaled-up OST, NSP, or both strategies) on the incidence of new HCV infection among PWID in Norway.
  • NOK 700,000 per quality-adjusted life year was used as a cost-efficacy threshold.
  • Funding: None.  

Key results

  • HCV incidence reduction with individual interventions ranged from 55% to 74%.
  • Screening by GPs while simultaneously enabling treatment of all patients was the most cost-effective screening strategy, yielding an estimated 63% reduction in HCV incidence by 2030.
  • Combining scaled-up OST + NSP was the most cost-effective harm-reduction intervention, yielding an estimated 80% reduction in HCV incidence by 2030.

Limitations

  • Limited randomized data to support model.