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Cost-Effectiveness of Scaling Up HCV Prevention and Treatment in the United States for People Who Inject Drugs
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August 02 2019
Source: Addiction. 114(12):2267-2278
[PDF-717.99 KB]
Details:
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Alternative Title:Addiction
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Personal Author:
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Description:Aims:
To examine the cost-effectiveness of hepatitis C (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 and measuring benefits in quality-adjusted life-years (QALYs).
Setting:
Rural Perry County, Kentucky (PC), and urban San Francisco, California (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 collected between 1998 and 2015 from Social Networks Among Appalachian People, U Find Out, Urban Health Study, and National HIV Behavioral Surveillance System studies.
Measurements:
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. Incremental cost-effectiveness ratios (ICERs) and uncertainty using cost-effectiveness acceptability curves.
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 1,852 more HCV infections, increases QALYS by 3,095, costs $21.6 million more, and has an ICER of $6,975/QALY. For SF, Intervention 2 averts 36,473 more HCV infections, increases QALYs by 78,93, 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.
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Subject:
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Source:
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Pubmed ID:31307116
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Pubmed Central ID:PMC7751348
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