Cost-Effectiveness of Scaling Up HCV Prevention and Treatment in the United States for People Who Inject Drugs

Details

• Journal Article:
  Addiction
• Personal Author:
  Barbosa, Carolina ; Fraser, Hannah ; Hoerger, Thomas J. ; Leib, Alyssa ; Havens, Jennifer R. ; Young, April ; Kral, Alex ; Page, Kimberly ; Evans, Jennifer ; Zibbell, Jon ; Hariri, Susan ; Vellozzi, Claudia ; Nerlander, Lina ; Ward, John W. ; Vickerman, Peter
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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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• Subjects:
  • Antiviral Agents
  • Cost-Benefit Analysis
  • Diagnostic Screening Programs
  • Hepatitis C
  • Humans
  • Kentucky
  • Models, Economic
  • Needle-Exchange Programs
  • Opiate Substitution Treatment
  • Rural Population
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• Keywords:
  • Hepatitis C
  • persons who inject drugs
  • opioid
  • modeling
  • cost-effectiveness analysis
  • medication-assisted treatment
  • syringe-service programs
  • direct-acting-antiviral HCV treatment
• Source:
  Addiction. 114(12):2267-2278
• DOI:
  http://dx.doi.org/10.1111/add.14731
• Pubmed ID:
  31307116
• Pubmed Central ID:
  PMC7751348
• Document Type:
  Text ; Journal Article
• Funding:
  R01 DA024598/DA/NIDA NIH HHSUnited States/ ; 200-2013-M-53964B GS-10F-0097L/CC/CDC HHSUnited States/ ; R01 DA016017/DA/NIDA NIH HHSUnited States/ ; UL1 TR001449/TR/NCATS NIH HHSUnited States/ ; R01 DA033862/DA/NIDA NIH HHSUnited States/ ; R01 DA037773/DA/NIDA NIH HHSUnited States/
• Genre:
  Journal Article
• Volume:
  114
• Issue:
  12
• Download URL:
  https://stacks.cdc.gov/view/cdc/99815/cdc_99815_DS1.pdf
• File Type:
  [PDF - 717.99 KB]
• Collection(s):
  CDC Public Access
• Main Document Checksum:
  urn:sha-512:097b30ef2e66304012ff1471a86d76722523b5634b52373cba7cf452c2846babf8e75d460e86dd04ff652680d396b3fa479d70a291a540760de9057c1f066145