Cost-effectiveness of the HepCATT intervention in specialist drug clinics to improve case-finding and engagement with HCV treatment for people who inject drugs in England

BACKGROUND AND AIMS: People who inject drugs (PWID) are at high risk of Hepatitis C virus (HCV) infection; however ~50% are undiagnosed in England and linkage-to-care is poor. This study investigated the cost-effectiveness of an intervention (HepCATT) to improve case-finding and referral to HCV treatment compared with standard-of-care pathways in drug treatment centres (DTCs) in England.

DESIGN: HCV transmission and disease progression model with cost-effectiveness analysis using a health-care perspective. Primary outcome and cost data from the HepCATT study parameterised the intervention, suggesting HepCATT increased HCV testing in DTCs 2.5-fold and engagement onto the HCV treatment pathway 10-fold. Model was used to estimate the decrease in HCV infections and HCV-related deaths from 2016, with costs and health benefits (quality-adjusted life-years or QALYs) tracked over 50 years. Univariable and probabilistic sensitivity analyses (PSA) were undertaken.

SETTING: England specific epidemic with 40% prevalence of chronic HCV among PWID.

PARTICIPANTS: PWID attending DTCs.

INTERVENTION: Nurse facilitator in DTCs to improve the HCV care pathway from HCV case-finding to referral and linkage to specialist care. Comparator was the standard-of-care HCV care pathway.

MEASUREMENTS: Incremental cost-effectiveness ratio (ICER) in terms of cost per QALY gained through improved case-finding.

FINDINGS: Over 50-years per 1000 PWID, the HepCATT intervention could prevent 75 (95% central interval 37-129) deaths and 1,330 (827-2,040) or 51% (30-67%) of all new infections. The mean ICER was £7,986 per QALY gained, with all PSA simulations being cost-effective at a £20,000 per QALY willingness-to-pay threshold. Univariable sensitivity analyses suggest the intervention would become cost-saving if the cost of HCV treatment reduces to £3,900. If scaled up to all PWID in England, the intervention would cost £8.8 million and decrease incidence by 56% (33-70%) by 2030.

CONCLUSIONS: Increasing Hepatitis C virus (HCV) infection case-finding and treatment referral in drug treatment centres could be a highly cost-effective strategy for decreasing HCV incidence among people who inject drugs.