OBJECTIVES: With the increased efficacy and tolerability of all-oral direct-acting antivirals (DAAs) against hepatitis C virus (HCV) infection, there is a growing will to treat all patients. Our objective is to determine the optimal and budget-feasible treatment path towards diagnosed HCV elimination in France.

METHODS: Using a sequential multi-cohort model, the diagnosed HCV population in France, 68% of the 150,000 prevalent cases, was projected over a 20-year horizon from the payer perspective. Treatment effectiveness was based on clinical trial data of second-generation pangenotypic DAAs. Treatment course was assumed to cost 30,000€. A declining treatment budget was considered from 600M€ in 2017 to 500M€ in 2018 and 400M€ beyond. Two treatment scenarios were compared: the recently adopted policy in France of generalized treatment which treats proportionally all fibrosis stages, and a top-down strategy which treats the most serious fibrosis stages first and the less serious stages last according to the budget constraint.

RESULTS: Our model-based analysis demonstrates that the elimination of diagnosed HCV is budget-feasible and could be reached in 2024 with the current universal treatment policy: 103,927 treated patients, 776 liver transplant, 4,445 liver-related deaths and 787,895 QALYs for a global budget of 3,7B€ over the 20 years. However, it is dominated by the top-down strategy, resulting in 4,661 less patients treated, 1,718 more liver-related deaths, 18,935 QALY lost, and 434M€ more healthcare spending. The undiagnosed population in 2024 is still of 45,964 patients.

CONCLUSIONS: Widespread access to DAAs is an important milestone to reach WHO elimination goal in 2030 but the more severe patients still need to be prioritized from public health and efficiency perspectives. Full elimination of HCV requires increased investments for screening and treatment, and greater awareness and urgency to treat.