Modelling Hepatitis C Infections Among People Who Inject Drugs in Turkey: Is HCV Elimination Possible?

Hepatitis C (HCV) is one of the major infectious diseases in the world. Injection drug users (PWID) is a population who is at higher risk of acquisition of HCV due to risky behaviors such as needle sharing, and they are considered as an important factor in the spread of the disease. World Health Organization (WHO) aims to eliminate hepatitis C disease by 2030 with the help of approval and dissemination of newly developed direct-acting antiviral treatment regimes. In this study, we evaluated the cost-effectiveness of hepatitis C treatment among injected drug users in Turkey to observe whether it is possible to reach WHO targets. Purpose of our model is to determine the infected population in the future, and we simulated the injected drug user population with a time horizon of 20 years. We developed five scenarios to represent different levels of treatment coverage. We included treatment regimens that are available in Turkey and that are reimbursed by the government health care insurance policies, which roughly covers over 90% of the Turkish population. Our model objective is (i) to predict the spread of HCV in the next 20 years, (ii) to determine the cost of new treatment regimens available to Turkish PWID population and (iii) to estimate the cost-effectiveness of these regimes. Our results indicate that HCV infected PWIDs could significantly decrease with treatment while the lowest total cost of treatment could be achieved with Viekirax Exviera and Mavyret. Also, it is possible to reach WHO targets by 2030 in Turkey if the treatment coverage increases.