An intensive model of care for hepatitis C virus screening and treatment with direct-acting antivirals in people who inject drugs in Nairobi, Kenya: A model-based cost-effectiveness analysis

Research output: Contribution to journalArticle (Academic Journal)peer-review

Abstract

Background and aims: Hepatitis C virus (HCV) treatment is essential for eliminating HCV in people who inject drugs (PWID) but has limited coverage in resource-limited settings. We measured the cost-effectiveness of a pilot HCV screening and treatment intervention using directly-observed therapy among PWID attending harm reduction services in Nairobi, Kenya.

Design: We utilised an existing model of HIV and HCV transmission among current and former PWID in Nairobi to estimate the cost-effectiveness of screening and treatment for HCV, including prevention benefits, versus no screening and treatment. The cure rate of treatment and costs for screening and treatment were estimated from intervention data, while other model parameters were derived from literature. Cost-effectiveness was evaluated over a lifetime horizon from the healthcare provider’s perspective. One-way and probabilistic sensitivity analyses were performed.

Setting: Nairobi, Kenya

Population: PWID

Measurements: Treatment costs, incremental cost-effectiveness ratio (cost per disability adjusted life year averted).

Findings: The cost per disability adjusted life year averted for the intervention was US$975, with 92.1% of the probabilistic sensitivity analyses simulations falling below the per capita gross domestic product for Kenya (US$1,509; commonly used as a suitable threshold for determining whether an intervention is cost-effective). However, the intervention was not cost-effective at the opportunity cost-based cost-effectiveness threshold of $647 per disability adjusted life year averted. Sensitivity analyses showed that the intervention could provide more value for money by including modelled estimates for HCV disease care costs, assuming lower drug prices ($75 instead of $728 per course) and excluding directly-observed therapy costs.

Conclusions: The current strategy of screening and treatment for hepatitis C virus (HCV) among people who inject drugs in Nairobi is likely to be highly cost-effective with currently available cheaper drug prices, if directly-observed therapy is not used and HCV disease care costs are accounted for.
Original languageEnglish
JournalAddiction
Early online date29 Jun 2021
DOIs
Publication statusPublished - 29 Jun 2021

Bibliographical note

Funding Information:
Funding for this study was provided by Unitaid (grant SPHQ14‐LOA‐217) and Médecins Sans Frontières. P.V., H.F. and J.S. are supported by the National Institute for Health Research Health Protection Research Units (NIHR HPRUs) in Evaluation of Interventions and Behavioural Science at the University of Bristol in partnership with Public Health England (PHE). M.H., P.V. and H.F. also acknowledges support from the NIHR‐funded EPIToPe project. P.V., H.F. and J.S. also acknowledge support from the US National Institute for Drug Abuse (NIDA grant number R01 AI147490, R01 DA033679, R01 DA037773, R21 DA046809 and R01 DA047952). P.V., J.S., B.M. and H.F. acknowledge support from Global Fund to Fight AIDS, Tuberculosis and Malaria, grant/award number: QPB‐H‐KANCO grant number 861. M.A., P.C., A.K. acknowledge support from grants (numbers R01DA032080 and R01DA032080‐05S1, awarded to Principal Investigators A.K. and P.C.) from the National Institute on Drug Abuse.

Publisher Copyright:
© 2021 Society for the Study of Addiction

Keywords

  • HCV
  • direct-acting antiviral treatment
  • people who inject drugs
  • low-income setting
  • cost-effectiveness

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