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Title: Cost effectiveness analysis of hepatitis C case finding strategies using direct linkage into care
Author: Selvapatt, Nowlan
ISNI:       0000 0004 6423 5087
Awarding Body: Imperial College London
Current Institution: Imperial College London
Date of Award: 2017
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It is estimated that more than 50% of persons with hepatitis C in the UK remain undiagnosed, which should be considered a failure of current screening processes. Further, treatment uptake is poor and linkage and retention to care is a significant barrier to virus elimination. In this thesis we demonstrate the impact of long term linkage to care using the example of hepatocellular carcinoma surveillance. We demonstrate that in scenarios where patients are required to followed up long term, there are currently significant shortfalls in maintaining linkage to specialist services. In at least 40% of cases, lack of linkage was not due to patient related factors and were institutional failures. We also evaluated the impact of hepatitis C cirrhosis on hospital admissions. Patients who did not achieve SVR were associated with more frequent admission events and more days of admission. Whilst it is unclear if this was primarily associated with greater likelihood of advanced liver disease solely it does provide a compelling argument for treatment at earlier stages of disease. After demonstrating the burden of disease, health economic evaluation was performed comparing real-life screening and treatment outcomes in a drug-treatment unit, antenatal screening service and a homeless shelter. In all scenarios the screening was followed by direct linkage into specialist services aiming to increase retention. Finally a exploratory analysis was performed on a UK birth cohort screening programme using real-world age distributions of hepatitis C patients. All health economic analysis was performed using a validated hepatitis C natural history Markov modelling model. Hepatitis C screening at varying viraemic prevalences as seen in the drug treatment unit (41%) and antenatal screening (0.16%) are demonstrably cost-effective as long as patients are appropriately linked up to care with specialist services to reap the benefits of SVR at earlier stages of disease and minimise onward virus related liver complications.
Supervisor: Thursz, Mark ; Brown, Ashley Sponsor: Not available
Qualification Name: Thesis (Ph.D.) Qualification Level: Doctoral