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Background and Aims: Chronic hepatitis B infection (defined as sustained detection of hepatitis B virus [HBV] surface antigen [HBsAg] protein in serum) is a leading cause of cirrhosis, hepatocellular carcinoma and liver-related deaths. A situation analysis carried out by the Swiss Federal Office of Public Health estimated the HBsAg prevalence in Switzerland to be 0.53% (95% CI: 0.32-0.89%) in 2015 (~44,000 cases). A lower prevalence of chronic HBV in the younger generation and the adoption of universal coverage in the first year of life are expected to decrease the burden of HBV; however, a number of people in key populations (including migrants) remain undiagnosed and untreated, and infected individuals remain at risk of progressing to cirrhosis, hepatocellular carcinoma and death. Our primary objective was to examine the current and estimate the future disease burden of HBV in Switzerland and the impact of migration. The secondary objective was to estimate the impact of changing future treatment numbers., Methods: A modelling study was performed using an existing, validated model (PRoGReSs Model) applied to the Swiss context. Model inputs were selected through a literature search and expert consensus. Population data from the Federal Statistical Office were used alongside prevalence data from the Polaris Observatory to estimate the number of HBV infections among people born abroad. The PRoGReSs Model was populated with and calibrated to the available data and what-if scenarios were developed to explore the impact of intervention on the future burden of disease. A Monte Carlo simulation was used to estimate 95% uncertainty intervals (95% UIs)., Results: In 2020, there were an estimated 50,100 (95% UI: 47,500-55,000) HBsAg+ cases among people born abroad. Among people born in Switzerland, there were approximately 62,700 (UI: 58,900-68,400) total HBV infections (0.72% [UI: 0.68-0.79%] prevalence). Prevalence among infants and children under the age of 5 were both <0.1%. By 2030, prevalence of HBV is expected to decrease, although morbidity and mortality will increase. Increasing diagnosis (90%) and treatment (80% of those eligible) to meet the global health sector strategy on viral hepatitis programme targets could prevent 120 cases of hepatocellular carcinoma and 120 liver-related deaths., Conclusions: Thanks to the historical vaccination programmes and the continued rollout of universal 3-dose coverage in the first year of life, Switzerland is expected to exceed the global health sector strategy targets for the reduction of incidence. While overall prevalence is decreasing, the current diagnosis and treatment levels remain below global health sector strategy targets.

Background and Aims: A previous analysis of hepatitis C virus (HCV)-related healthcare costs in Switzerland found that the annual healthcare costs of untreated HCV infection (excluding antiviral treatment) could increase by more than 25 million Swiss francs (CHF) between 2013 and 2030. Since that publication, highly efficacious direct-acting antiviral therapies (DAAs) have become available, making HCV elimination a possibility. This analysis quantifies the clinical and economic burden of HCV intervention strategies over the next 15 years., Methods: A model was developed to estimate the future clinical and economic burden of HCV infection if patients are diagnosed and treated according to a historical paradigm (historical base case), or at higher levels without treatment reimbursement restrictions (Scenario 1). The infected population was tracked by age- and sex-defined cohorts, and associated direct medical costs (healthcare, screening, diagnostics and treatment) and quality-adjusted life years (QALYs) were calculated. Direct cost savings and the incremental cost-effectiveness ratio (ICER) were calculated to assess the economic impact of each scenario. Additionally, we generated a net-zero cost scenario (Scenario 2), assuming the same treatment paradigm as Scenario 1 but at the treatment price that would break even by 2031., Results: In the historical base case, annual direct costs are projected to decrease from 150 million (95% UI: 132&ndash;170 million) CHF in 2016 to 90 million (95% UI: 65&ndash;111 million) CHF in 2031. Cumulative direct costs are projected to reach 1.7 billion (95% UI: 1.2&ndash;2.0 billion) CHF by 2031. In Scenario 1, annual direct costs first increased to 175 million CHF by 2018, before declining to 44 million CHF by 2031. Cumulative direct costs in this scenario are projected to reach 1.8 billion CHF by 2031. For Scenario 2, the treatment price needed to achieve break-even by 2031 considering only direct costs would be 27,900 CHF per patient. By 2031, Scenarios 1 and 2 would gain 58,300 QALYs. In both scenarios, the ICER drops below the cost-effectiveness threshold of 78,000 CHF in 2018. Over the 15-year span, the ICER was determined to be 2,200 CHF for Scenario 1., Conclusions: Increasing the number of patients treated and treating all fibrosis stages is cost-effective compared to the historical base case and could achieve break-even by 2031 at a price of 27,900 CHF.

Background and Aims: Direct-acting antiviral agents have revolutionised hepatitis C treatment. In 2014, the Swiss Hepatitis Strategy was developed to eliminate hepatitis C virus (HCV) infection and the associated liver-related morbidity and mortality by 2030. Though numerous national studies and assessments have identified a relatively low prevalence rate of 0.7% in the country, little has been done to identify the epidemiology of HCV on the regional, or micro, level. This study aimed to identify scenarios to achieve the objectives of Swiss Hepatitis Strategy by 2030 in eastern, western and northern regions in Switzerland., Methods: Three Excel-based Markov disease burden models, based on hospital- and region-specific data, were developed to forecast the current and future prevalence of HCV infection by fibrosis stage and liver disease stage to 2030. Two scenarios were developed to evaluate the disease burden in St Gallen, Geneva and Zurich: a Base 2016 scenario, representing the current standard of care in each canton, and a second, potential scenario to achieve the Swiss Hepatitis Strategy goals., Results: In 2015, the estimated viraemic prevalence in St Gallen was 0.5% (0.5&ndash;0.6%) corresponding to 2800 (2600&ndash;3100) cases. In Geneva and Zurich, the estimated prevalence was slightly higher, with an estimated 0.7% (0.6&ndash;0.7%) viraemic prevalence, or 3300 (3000&ndash;3600) cases in Geneva and 0.7% (0.7&ndash;0.8%) viremic prevalence, or 10,800 (9900&ndash;11,900) infectionsin Zurich. In order to achieve the Swiss Hepatitis Strategy goals of a 30% reduction in new infections, total viraemic infections, liver transplants, and hepatocellular carcinoma cases by 2020 and a 90% reduction by 2030, all regions will need to increase the annual number of treated and diagnosed patients up to 2030. In St Gallen, an up-front investment to treat 430 patients annually by 2020 would be necessary, to achieve the 2020 goals. After 2020, treatment could be reduced to ~150 patients annually until 2030. The number of patients diagnosed, however, would need to be sustained at 130 annually after 2020. In Geneva, 235 patients need to be treated, with 140 diagnosed annually between 2019 and 2030 to achieve both 2020 and 2030 goals. In Zurich, 850 patients will need to be treated annually in 2019 and 2020 and the number of diagnosed will need to expand to 350 individuals annually by 2022., Conclusions: Intensified screening for chronic hepatitis C and increased access to direct-acting antivirals are necessary to meet the Swiss hepatitis strategy elimination goals over the next 12 years.

Background and Aims: In Switzerland, the prevalence of hepatitis C virus (HCV) among people who inject drugs (PWID) has been decreasing owing to active harm reduction efforts and an aging population. Recent advances in HCV therapeutics may provide an opportunity to direct treatment to high-risk populations, with a goal of reducing HCV prevalence and preventing new infections. In order to guide these efforts, the current project was undertaken with the following aims: (1) to develop a simple model to estimate the number of new HCV infections using available data on PWID; (2) to examine the impact of intervention strategies (prevention and treatment) on new and total HCV infections among PWID., Methods: A dynamic HCV transmission model was used to track HCV incidence and prevalence among active PWID according to their harm reduction status. The relative impact of treating 1, 5, 10 or 15% of HCV+ PWID with new oral direct acting antivirals was considered., Results: In 2015, there were an estimated 10 160 active PWID in Switzerland, more than 85% of whom were engaged in harm reduction programmes. Approximately 42% of active PWID were HCV-RNA+, with 55 new viraemic infections occurring annually. By 2030, a 60% reduction in the HCV+ PWID population would be expected. In the absence of behavioural changes, the number of secondary infections would increase under all treatment scenarios. With high level treatment, the number of secondary infections would peak and then drop, corresponding to depletion of the viral pool. In Switzerland, 5% treatment of the 2015 HCV+ PWID population per year would result in a 95% reduction in total cases by 2030, whereas ≥10% treatment would result in a >99% reduction., Conclusions: Timely treatment of hepatitis C virus among people who inject drugs is necessary to reduce the prevalence and prevent new infections in Switzerland.