Hepatitis C Virus (HCV) Treatment as Prevention: Epidemic and Cost-Effectiveness Modeling

Abstract Hepatitis C virus (HCV), a leading cause of morbidity and mortality worldwide, is a blood-borne disease. Without treatment, chronic HCV infection can progress to serious liver complications including cirrhosis, liver cancer, or end-stage liver disease. One of the main risk groups for HCV transmission is people who inject drugs, where approximately 67% have a history of HCV infection globally. There is no vaccine for HCV, but traditional harm reduction interventions such as needle and syringe programs and opiate substitution therapy are effective at preventing the acquisition of HCV, but are insufficient to eliminate HCV in isolation. Recent development of short duration and highly tolerable direct-acting antiviral therapy for HCV can result in cure in u003e90% of individuals. In addition to the individual benefits of treatment, HCV treatment for those at risk of transmission could also act as a means of prevention. In this chapter, we review the global epidemiology of HCV, and we discuss how epidemic and economic modeling has been used to assess the impact and cost-effectiveness of HCV treatment as prevention.