Aims: To examine the cost-effectiveness of hepatitis C virus (HCV) treatment of people who inject drugs (PWID), combined with medication-assisted treatment (MAT) and syringe-service programs (SSP), to tackle the increasing HCV epidemic in the United States. Design: HCV transmission and disease progression models with cost-effectiveness analysis using a health-care perspective. Setting: Rural Perry County, KY (PC) and urban San Francisco, CA (SF), USA. Compared with PC, SF has a greater proportion of PWID with access to MAT or SSP. HCV treatment of PWID is negligible in both settings. Participants: PWID data were collected between 1998 and 2015 from Social Networks Among Appalachian People, U Find Out, Urban Health Study and National HIV Behavioral Surveillance System studies. Interventions and comparator: Three intervention scenarios modeled: baseline—existing SSP and MAT coverage with HCV screening and treatment with direct-acting antiviral for ex-injectors only as per standard of care; intervention 1—scale-up of SSP and MAT without changes to treatment; and intervention 2—scale-up as intervention 1 combined with HCV screening and treatment for current PWID. Measurements: Incremental cost-effectiveness ratios (ICERs) and uncertainty using cost-effectiveness acceptability curves. Benefits were measured in quality-adjusted life-years (QALYs). Findings: For both settings, intervention 2 is preferred to intervention 1 and the appropriate comparator for intervention 2 is the baseline scenario. Relative to baseline, for PC intervention 2 averts 1852 more HCV infections, increases QALYS by 3095, costs $21.6 million more and has an ICER of $6975/QALY. For SF, intervention 2 averts 36 473 more HCV infections, increases QALYs by 7893, costs $872 million more and has an ICER of $11 044/QALY. The cost-effectiveness of intervention 2 was robust to several sensitivity analysis. Conclusions: Hepatitis C screening and treatment for people who inject drugs, combined with medication-assisted treatment and syringe-service programs, is a cost-effective strategy for reducing hepatitis C burden in the United States.
|Number of pages||12|
|State||Published - Dec 1 2019|
Bibliographical noteFunding Information:
Financial support for this study was provided by Contract no. 200–2013-M-53964B GS-10F-0097L from the Centers for Disease Control and Prevention (CDC) to RTI International and a subcontract from RTI International to the University of Bristol. The findings and conclusions in this paper are those of the authors and do not necessarily represent the official position of CDC, RTI International or the University of Bristol, the NHS, the NIHR, the Department of Health and Social Care or Public Health England. P.V. was additionally supported by the National Institute for Drug Abuse [grant number R01 DA037773]. J.E. and K.P. were supported by the National Institute for Drug Abuse (3-R01 DA016017–14), as was J.H. (R01 DA024598). P.V. acknowledges that the research was supported by the National Institute for Health Research Health Protection Research Unit (NIHR HPRU) in Evaluation of Interventions at the University of Bristol in partnership with Public Health England (PHE). P.V. has received unrestricted research grants from Gilead unrelated to this work. H.F. has received an honorarium from MSD. K.P. has received research grant funding from Gilead unrelated to this work. All authors declare no conflicts of interest. C.V. was an employee of the US Centers for Disease Control and Prevention at the time the study began. A.L. was an employee of RTI International at the time the study began. The authors thank Yea-Hung Chen at the San Francisco Department of Public Health for providing analyses on prevalence data for our sensitivity analysis.
© 2019 Society for the Study of Addiction
- Cost-effectiveness analysis
- direct-acting antiviral HCV treatment
- hepatitis C
- medication-assisted treatment
- opioid modeling
- people who inject drugs
- syringe-service programs
ASJC Scopus subject areas
- Medicine (miscellaneous)
- Psychiatry and Mental health