Cost-effectiveness of scaling-up HCV prevention and treatment in the United States for people who inject drugs

Carolina Barbosa, Hannah Fraser, Thomas Hoerger, Alyssa Leib, Jennifer Havens, April Young, Alex H. Kral, Kimberly Page, Jennifer Evans, Jon Zibbell, Susan Hariri, Claudia Vellozzi, Lina Nerlander, John Ward, Peter Vickerman

Research output: Contribution to journalArticle (Academic Journal)

1 Citation (Scopus)

Abstract

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.
Original languageEnglish
Number of pages12
JournalAddiction
Early online date2 Aug 2019
DOIs
Publication statusE-pub ahead of print - 2 Aug 2019

Keywords

  • Hepatitis C
  • persons who inject drugs
  • opioid, modeling
  • cost-effectiveness analysis, medication-assisted treatment
  • syringe-service programs
  • direct-acting-antiviral HCV treatment

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  • Cite this

    Barbosa, C., Fraser, H., Hoerger, T., Leib, A., Havens, J., Young, A., Kral, A. H., Page, K., Evans, J., Zibbell, J., Hariri, S., Vellozzi, C., Nerlander, L., Ward, J., & Vickerman, P. (2019). Cost-effectiveness of scaling-up HCV prevention and treatment in the United States for people who inject drugs. Addiction. https://doi.org/10.1111/add.14731