Abstract
Background & Aims: The INTRO-HCV randomised controlled trial conducted in Norway over 2017-2019 found that integrated treatment, compared with standard-of-care hospital treatment, for hepatitis C virus (HCV) with direct-acting antivirals (DAAs) improved treatment outcomes among people who inject drugs (PWID). We evaluated cost-effectiveness of the INTRO-HCV intervention.
Design: A Markov health state transition model of HCV disease progression and treatment with cost-effectiveness analysis from the health-provider perspective. Primary cost, utility, and health outcome data were derived from the trial. Costs and health benefits (quality-adjusted life years, QALYs) were tracked over 50 years. Probabilistic and univariate sensitivity analyses investigated DAA price reductions and variations in HCV treatment and disease care cost assumptions, using costs from different countries (Norway, United Kingdom, United States, France, Australia).
Setting and participants: PWID attending community-based drug treatment centres for people with opioid dependence in Norway.
Measurements: Incremental cost-effectiveness ratio (ICER) in terms of cost per QALY gained, compared against a conventional (€70,000/QALY) willingness-to-pay threshold for Norway and lower (€20,000/QALY) threshold common among high-income countries.
Findings: Integrated treatment resulted in an ICER of €13,300/QALY gained, with 99% and 71% probability of being cost-effective against conventional and lower willingness-to-pay thresholds, respectively. A 30% lower DAA price reduced the ICER to €6,900/QALY gained, with 91% probability of being cost-effective at the lower willingness-to-pay threshold. A 60% and 90% lower DAA price had 36% and >99% probability of being cost-saving, respectively. Sensitivity analyses suggest integrated treatment was cost-effective at the lower willingness-to-pay threshold (>60% probability) across different assumptions on HCV treatment and disease care costs with 30% DAA price reduction, and became cost-saving with 60-90% price reductions.
Conclusions: Integrated hepatitis C virus treatment for people who inject drugs in community settings is likely cost-effective compared with standard-of-care referral pathways in Norway and may be cost-saving in settings with particular characteristics.
Design: A Markov health state transition model of HCV disease progression and treatment with cost-effectiveness analysis from the health-provider perspective. Primary cost, utility, and health outcome data were derived from the trial. Costs and health benefits (quality-adjusted life years, QALYs) were tracked over 50 years. Probabilistic and univariate sensitivity analyses investigated DAA price reductions and variations in HCV treatment and disease care cost assumptions, using costs from different countries (Norway, United Kingdom, United States, France, Australia).
Setting and participants: PWID attending community-based drug treatment centres for people with opioid dependence in Norway.
Measurements: Incremental cost-effectiveness ratio (ICER) in terms of cost per QALY gained, compared against a conventional (€70,000/QALY) willingness-to-pay threshold for Norway and lower (€20,000/QALY) threshold common among high-income countries.
Findings: Integrated treatment resulted in an ICER of €13,300/QALY gained, with 99% and 71% probability of being cost-effective against conventional and lower willingness-to-pay thresholds, respectively. A 30% lower DAA price reduced the ICER to €6,900/QALY gained, with 91% probability of being cost-effective at the lower willingness-to-pay threshold. A 60% and 90% lower DAA price had 36% and >99% probability of being cost-saving, respectively. Sensitivity analyses suggest integrated treatment was cost-effective at the lower willingness-to-pay threshold (>60% probability) across different assumptions on HCV treatment and disease care costs with 30% DAA price reduction, and became cost-saving with 60-90% price reductions.
Conclusions: Integrated hepatitis C virus treatment for people who inject drugs in community settings is likely cost-effective compared with standard-of-care referral pathways in Norway and may be cost-saving in settings with particular characteristics.
| Original language | English |
|---|---|
| Pages (from-to) | 2424-2439 |
| Number of pages | 16 |
| Journal | Addiction |
| Volume | 118 |
| Issue number | 12 |
| Early online date | 29 Jul 2023 |
| DOIs | |
| Publication status | E-pub ahead of print - 29 Jul 2023 |
Bibliographical note
Funding Information:This study is part of the main INTRO‐HCV study, which was funded by the Norwegian Research Council (Norges Forskningsråd) (no. 269855) and the Western Norway Regional Health Authority (Helse Vest) (Åpen prosjektstøtte) with Department of Addiction Medicine, Haukeland University Hospital as responsible institution. A.G.L. and P.V. acknowledge support from the National Institute for Health and Care Research (NIHR) Health Protection Research Unit (HPRU) in Behavioural Science and Evaluation at the University of Bristol (NIHR200877). A.G.L. and P.V. acknowledge support from the Wellcome Trust (WT 220866/Z/20/Z) and UK NIHR (NIHR133208).
Funding Information:
P.V. has received unrestricted research grants from Gilead unrelated to this work. All other authors declare no competing interests.
Publisher Copyright:
© 2023 The Authors. Addiction published by John Wiley & Sons Ltd on behalf of Society for the Study of Addiction.
UN SDGs
This output contributes to the following UN Sustainable Development Goals (SDGs)
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SDG 3 Good Health and Well-being
Research Groups and Themes
- GEM-B
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