Article Figures & Tables
Figures
- Figure 1
State-transition model of hepatitis C virus (HCV) infection and progression. See Appendix 1, Supplementary Figure 1 for details of set of health states. Note: F0 = no fibrosis, F1 = portal fibrosis without septa, F2 = portal fibrosis with rare septa, F3 = numerous septa without cirrhosis, F4 = cirrhosis, SVR = sustained virologic response.
- Figure 2
Health events per 100 000 people screened accumulated over time for scenario 1, asymptomatic people not at high risk for hepatitis C virus (HCV) infection. Note: DAA = direct-acting antiviral, DC = decompensated cirrhosis, HCC = hepatocellular carcinoma.
- Figure 3
Health events per 100 000 people screened accumulated over time for scenario 2, immigrant populations with high prevalence. Note: DAA = direct-acting antiviral, DC = decompensated cirrhosis, HCC = hepatocellular carcinoma, HCV = hepatitis C virus.
- Figure 4
Health events per 100 000 people screened accumulated over time for scenario 3, specific birth cohort (25-64 yr of age). Note: DAA = direct-acting antiviral, DC = decompensated cirrhosis, HCC = hepatocellular carcinoma, HCV = hepatitis C virus.
- Figure 5
Health events per 100 000 people screened accumulated over time for scenario 4, specific birth cohort (45-64 yr of age). Note: DAA = direct-acting antiviral, DC = decompensated cirrhosis, HCC = hepatocellular carcinoma, HCV = hepatitis C virus.
Tables
Cohort Definition Asymptomatic people not at high risk for HCV infection Non-Aboriginal, nonimmigrant asymptomatic people (not suspected of having HCV infection) aged 15-79 yr living in Canada Immigrant populations with high prevalence People aged 15-79 yr granted the right to live in Canada permanently (including all landed immigrants, permanent residents, refugees and granted Canadian citizens); excludes those born outside Canada who are Canadian citizens by birth Specific birth cohort (25-64 yr) People aged 25-64 yr living in Canada Specific birth cohort (45-64 yr) People aged 45-64 yr living in Canada Note: HCV = hepatitis C virus.
Parameter Scenario 1. Asymptomatic people not at high risk for HCV infection 2. Immigrant populations with high prevalence 3. Specific birth cohort (25-64 yr) 4. Specific birth cohort (45-64 yr) Cost of dasabuvir plus ombitasvir-paritaprevir-ritonavir, $9 55 860 55 860 55 860 55 860 Cost of ledipasvir plus sofosbuvir, $9 67 000 67 000 67 000 67 000 Cost of pegylated interferon-ribavirin, $9 19 075 19 075 19 075 19 075 Prevalence of HCV infection (range) 0.2 (0.10-0.30)3 1.9 (1.30-2.60)3 14-49 yr: 0.4 (0.2-0.7)
50-79 yr: 0.8 (0.4-1.5)214-49 yr: 0.4 (0.2-0.7)
50-79 yr: 0.8 (0.4-1.5)2Uptake of screening (range), %* 89.5 (70-100) 76.6 (60-100) 89.5 (60-100) 90 (76-100) Uptake of treatment (range), %* 80 (80-100) 95 (80-100) 95 (80-100) 80 (80-100) Known chronic HCV infection2 0.305 0.305 0.305 0.305 Age distribution10 15-24 yr: 0.17 15-24 yr: 0.10 25-34 yr: 0.20 45-54 yr: 0.54 25-34 yr: 0.17 25-34 yr: 0.15 35-44 yr: 0.27 55-64 yr: 0.46 35-44 yr: 0.17 35-44 yr: 0.21 45-54 yr: 0.29 - 45-54 yr: 0.20 45-54 yr: 0.22 55-64 yr: 0.24 - 55-64 yr: 0.16 55-64 yr: 0.19 - - 65-74 yr: 0.10 65-74 yr: 0.10 - - 75-79 yr: 0.03 75-79 yr: 0.03 - - Distribution of fibrosis stage for all cohorts (range), %* Age 15-34 yr Age 35-44 yr Age 45-54 yr Age 55-79 yr F0 45 (30-35) 10 (5-15) 5 (0-10) 5 (0-10) F1 45 (30-55) 43 (30-60) 25 (15-30) 10 (5-15) F2 8 (5-20) 13 (13-60) 25 (25-45) 15 (10-20) F3 1 (0-5) 19 (5-20) 25 (20-30) 45 (40-60) F4 1 (0-5) 15 (0-20) 20 (5-35) 25 (15-40) Note: HCV = hepatitis C virus.
*Clinical experts' opinion.
Parameter Description Baseline† or RR Lower limit (95% CrI) Upper limit (95% CrI) Treatment efficacy (sustained virologic response) Genotype 1 Noncirrhosis Reference baseline PR48 Pegylated interferon + ribavirin for 48 wk 0.4913† 0.4359 0.5456 SOF12 + LDV12 Sofosbuvir + ledipasvir for 12 wk 1.978 1.78 2.225 PAR/RIT12 + OMB12 + DAS12 Paritaprevir-ritonavir + ombitasvir + dasabuvir for 12 wk 1.932 1.337 2.211 Cirrhosis Reference baseline PR48 0.3898† 0.3099 0.475 SOF12 + LDV12 2.442 1.956 3.091 PAR/RIT12 + OMB12 + DAS12 + RBV12 Paritaprevir-ritonavir + ombitasvir + dasabuvir + ribavirin for 12 wk 2.416 1.942 3.057 Genotype 2 Noncirrhosis SOF12 + RBV12 Sofosbuvir + ribavirin for 12 wk 1.16 1.083 1.244 Reference baseline PR24 Pegylated interferon + ribavirin for 24 wk 0.8191† 0.7687 0.8619 Cirrhosis SOF12 + RBV12 1.375 1.026 1.791 Reference baseline PR24 0.6209† 0.4966 0.7344 Genotype 3 Noncirrhosis Reference baseline PR48 0.7051† 0.6393 0.765 SOF24 + RBV24 Sofosbuvir + ribavirin for 24 wk 1.318 1.177 1.47 DCV12 + SOF12 Daclatasvir + sofosbuvir for 12 wk 1.375 1.233 1.525 Cirrhosis Reference baseline PR48 0.6021† 0.5584 0.6441 SOF24 + RBV24 1.509 1.142 1.702 Genotypes 4-6 PR48 0.65 0.57 0.71 Adverse events (treatment-naive people) Depression Reference baseline PR48 0.1381† 0.11 0.1683 SOF12 + RBV12 0.2861 0.07992 0.958 SOF24 + RBV24 0.7751 0.165 3.181 SOF12 + LDV12 0.01888 0.002205 0.09946 PAR/RIT12 + OMB12 + DAS12 + RBV12 0.4174 0.08099 1.534 PR24 0.756 0.1592 2.831 Anemia Reference baseline PR48 0.2136† 0.1838 0.2459 SOF12 + RBV12 0.6949 0.3601 1.309 SOF24 + RBV24 1.263 0.4806 2.528 SOF12 + LDV12 0.05568 0.02193 0.1322 PAR/RIT12 + OMB12 + DAS12 0.3454 0.1431 0.7469 PAR/RIT12 + OMB12 + DAS12 + RBV12 0.3826 0.1549 0.8366 PR24 0.9708 0.4121 2.065 Rash Reference baseline PR48 0.1828† 0.1465 0.2186 SOF12 + RBV12 0.5244 0.167 1.598 SOF24 + RBV24 0.7655 0.07902 2.721 SOF12 + LDV12 0.2626 0.1415 0.4803 PAR/RIT12 + OMB12 + DAS12 0.2194 0.08837 0.525 PAR/RIT12 + OMB12 + DAS12 + RBV12 0.7214 0.3777 1.301 PR24 1.03 0.3068 2.839 Treatment discontinuation rate Base estimate Lower limit (95% CI) Upper limit (95% CI) PR48 0.173 0.096 0.292 SOF12 + RBV12 0.089 0.038 0.194 SOF24 + RBV24 0.054 0.015 0.18 SOF12 + LDV12 0.044 0.023 0.083 PAR/RIT12 + OMB12 + DAS12 0.005 0.001 0.033 PAR/RIT12 + OMB12 + DAS12 + RBV12 0.015 0.003 0.071 Note: CI = confidence interval, CrI = credible interval, RR = relative risk.
*Source: references 9 and 11, with the exception of genotypes 4-6 (references 12-14).
†Baseline probability.
Scenario; strategy Cost, $ QALYs ΔCost, $ ΔQALYs ICER Scenario 1 No screening, treat with interferon-free direct-acting antiviral if diagnosed 69 769 14.0644 - - - Screen and treat with interferon-free direct-acting antiviral* 69 871-69 877 14.0664 102-108 0.0020 50 490-53 938 Scenario 2 No screening, treat with interferon-free direct-acting antiviral if diagnosed 72 765 13.7281 - - - Screen and treat with interferon-free direct-acting antiviral* 73 384-73 446 13.7478 619-681 0.0197 31 468-34 600 Scenario 3 No screening, treat with interferon-free direct-acting antiviral if diagnosed 72 506 14.2536 - - - Screen and treat with interferon-free direct-acting antiviral* 72 767-72 789 14.2615-14.2616 261-284 0.0080 32 712-35 619 Scenario 4 No screening, treat with interferon-free direct-acting antiviral if diagnosed 84 610 12.7979 - - - Screen and treat with interferon-free direct-acting antiviral* 84 914-84 938 12.8067 304-328 0.0088 34 614-37 167 Note: ICER = incremental cost-effectiveness ratio, QALY = quality-adjusted life-year.
*A range is given depending on which direct-acting antiviral is used for treating patients with genotype 1 infection.
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