Evaluating the cost-effectiveness of existing needle and syringe programmes in preventing Hepatitis C transmission in people who inject drugs

Sedona Sweeney; Zoe Ward; Lucy Platt; Lorna Guinness; Matthew Hickman; Vivian Hope; Lisa Maher; Jenny Iversen; Sharon J. Hutchinson; Josie Smith; Rachel Ayres; Ingrid Hainey; Peter Vickerman

doi:10.1111/add.14519

Evaluating the cost-effectiveness of existing needle and syringe programmes in preventing Hepatitis C transmission in people who inject drugs

Sedona Sweeney, Zoe Ward, Lucy Platt, Lorna Guinness, Matthew Hickman, Vivian Hope, Lisa Maher, Jenny Iversen, Sharon J. Hutchinson, Josie Smith, Rachel Ayres, Ingrid Hainey, Peter Vickerman

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Abstract

Aim: To evaluate the cost-effectiveness of needle and syringe programmes (NSPs) compared to no NSPs on hepatitis C virus (HCV) transmission in the United Kingdom.
Design: Cost-effectiveness analysis from NHS/ health-provider perspective, utilising a dynamic transmission model of HCV infection and disease progression, calibrated using city-specific surveillance and survey data, and primary data collection on NSP costs. The effectiveness of NSPs preventing HCV acquisition was based on empirical evidence.
Setting: UK settings with different chronic HCV prevalence among people who inject drugs (PWID): Dundee (26%), Walsall (18%), and Bristol (45%)
Population: PWID
Interventions: Current NSP provision is compared to a counterfactual scenario where NSPs are removed for 10 years and then returned to existing levels with effects collected for 40 years.

Measurements: HCV infections, and cost per quality adjusted life year (QALY) gained through NSPs over 50 years

Findings: Compared to a willingness-to-pay threshold of £20,000 per QALY gained, NSPs were highly cost-effective over a time-horizon of 50 years and decreased the number of HCV incident infections. The mean incremental cost-effectiveness ratio was cost-saving in Dundee and Bristol, and £596 per QALY gained in Walsall, with 78%, 46% and 40% of simulations being cost-saving in each city, respectively, with differences driven by coverage of NSP and HCV prevalence (lowest in Walsall). Over 90% of simulations were cost-effective at the willingness-to-pay threshold. Results were robust to sensitivity analyses including varying the time-horizon, HCV treatment cost and numbers of HCV treatments per year.

Conclusions: We projected NSPs avert HCV infections and are highly cost-effective in the UK and could be cost-saving to the NHS and other health care providers. NSPs will remain cost-effective in the UK irrespective of changes in HCV treatment cost and scale-up, meaning that NSPs will continue to be an efficient strategy for preventing HCV transmission in the future.

Original language	English
Pages (from-to)	560-570
Number of pages	11
Journal	Addiction
Volume	114
Issue number	3
Early online date	23 Jan 2019
DOIs	https://doi.org/10.1111/add.14519
Publication status	Published - 14 Feb 2019

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

SDG 3 Good Health and Well-being

Research Groups and Themes

GEM-B

Keywords

Harm reduction
mathematical modelling
needle exchange
injection drug use
hepatitis C virus
health economics

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10.1111/add.14519

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Professor Matt Hickman
- Matthew.Hickmanbristol.acuk
- Bristol Medical School (PHS) - Professor in Public Health and Epidemiology
- Bristol Population Health Science Institute
- Health Protection Research Unit (HPRU)
- Centre for Academic Mental Health
- Infection and Immunity
- Centre for Academic Primary Care
Person: Academic , Member, Group lead

Cite this

Sweeney, S., Ward, Z., Platt, L., Guinness, L., Hickman, M., Hope, V., Maher, L., Iversen, J., Hutchinson, S. J., Smith, J., Ayres, R., Hainey, I., & Vickerman, P. (2019). Evaluating the cost-effectiveness of existing needle and syringe programmes in preventing Hepatitis C transmission in people who inject drugs. Addiction, 114(3), 560-570. https://doi.org/10.1111/add.14519

@article{c770321c07dd481a94cf97f0e69a315a,

title = "Evaluating the cost-effectiveness of existing needle and syringe programmes in preventing Hepatitis C transmission in people who inject drugs",

abstract = "Aim: To evaluate the cost-effectiveness of needle and syringe programmes (NSPs) compared to no NSPs on hepatitis C virus (HCV) transmission in the United Kingdom. Design: Cost-effectiveness analysis from NHS/ health-provider perspective, utilising a dynamic transmission model of HCV infection and disease progression, calibrated using city-specific surveillance and survey data, and primary data collection on NSP costs. The effectiveness of NSPs preventing HCV acquisition was based on empirical evidence. Setting: UK settings with different chronic HCV prevalence among people who inject drugs (PWID): Dundee (26\%), Walsall (18\%), and Bristol (45\%) Population: PWID Interventions: Current NSP provision is compared to a counterfactual scenario where NSPs are removed for 10 years and then returned to existing levels with effects collected for 40 years. Measurements: HCV infections, and cost per quality adjusted life year (QALY) gained through NSPs over 50 years Findings: Compared to a willingness-to-pay threshold of £20,000 per QALY gained, NSPs were highly cost-effective over a time-horizon of 50 years and decreased the number of HCV incident infections. The mean incremental cost-effectiveness ratio was cost-saving in Dundee and Bristol, and £596 per QALY gained in Walsall, with 78\%, 46\% and 40\% of simulations being cost-saving in each city, respectively, with differences driven by coverage of NSP and HCV prevalence (lowest in Walsall). Over 90\% of simulations were cost-effective at the willingness-to-pay threshold. Results were robust to sensitivity analyses including varying the time-horizon, HCV treatment cost and numbers of HCV treatments per year. Conclusions: We projected NSPs avert HCV infections and are highly cost-effective in the UK and could be cost-saving to the NHS and other health care providers. NSPs will remain cost-effective in the UK irrespective of changes in HCV treatment cost and scale-up, meaning that NSPs will continue to be an efficient strategy for preventing HCV transmission in the future. ",

keywords = "Harm reduction, mathematical modelling, needle exchange, injection drug use, hepatitis C virus, health economics",

author = "Sedona Sweeney and Zoe Ward and Lucy Platt and Lorna Guinness and Matthew Hickman and Vivian Hope and Lisa Maher and Jenny Iversen and Hutchinson, \{Sharon J.\} and Josie Smith and Rachel Ayres and Ingrid Hainey and Peter Vickerman",

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doi = "10.1111/add.14519",

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Sweeney, S, Ward, Z, Platt, L, Guinness, L, Hickman, M, Hope, V, Maher, L, Iversen, J, Hutchinson, SJ, Smith, J, Ayres, R, Hainey, I & Vickerman, P 2019, 'Evaluating the cost-effectiveness of existing needle and syringe programmes in preventing Hepatitis C transmission in people who inject drugs', Addiction, vol. 114, no. 3, pp. 560-570. https://doi.org/10.1111/add.14519

TY - JOUR

T1 - Evaluating the cost-effectiveness of existing needle and syringe programmes in preventing Hepatitis C transmission in people who inject drugs

AU - Sweeney, Sedona

AU - Ward, Zoe

AU - Platt, Lucy

AU - Guinness, Lorna

AU - Hickman, Matthew

AU - Hope, Vivian

AU - Maher, Lisa

AU - Iversen, Jenny

AU - Hutchinson, Sharon J.

AU - Smith, Josie

AU - Ayres, Rachel

AU - Hainey, Ingrid

AU - Vickerman, Peter

PY - 2019/2/14

Y1 - 2019/2/14

N2 - Aim: To evaluate the cost-effectiveness of needle and syringe programmes (NSPs) compared to no NSPs on hepatitis C virus (HCV) transmission in the United Kingdom. Design: Cost-effectiveness analysis from NHS/ health-provider perspective, utilising a dynamic transmission model of HCV infection and disease progression, calibrated using city-specific surveillance and survey data, and primary data collection on NSP costs. The effectiveness of NSPs preventing HCV acquisition was based on empirical evidence. Setting: UK settings with different chronic HCV prevalence among people who inject drugs (PWID): Dundee (26%), Walsall (18%), and Bristol (45%) Population: PWID Interventions: Current NSP provision is compared to a counterfactual scenario where NSPs are removed for 10 years and then returned to existing levels with effects collected for 40 years. Measurements: HCV infections, and cost per quality adjusted life year (QALY) gained through NSPs over 50 years Findings: Compared to a willingness-to-pay threshold of £20,000 per QALY gained, NSPs were highly cost-effective over a time-horizon of 50 years and decreased the number of HCV incident infections. The mean incremental cost-effectiveness ratio was cost-saving in Dundee and Bristol, and £596 per QALY gained in Walsall, with 78%, 46% and 40% of simulations being cost-saving in each city, respectively, with differences driven by coverage of NSP and HCV prevalence (lowest in Walsall). Over 90% of simulations were cost-effective at the willingness-to-pay threshold. Results were robust to sensitivity analyses including varying the time-horizon, HCV treatment cost and numbers of HCV treatments per year. Conclusions: We projected NSPs avert HCV infections and are highly cost-effective in the UK and could be cost-saving to the NHS and other health care providers. NSPs will remain cost-effective in the UK irrespective of changes in HCV treatment cost and scale-up, meaning that NSPs will continue to be an efficient strategy for preventing HCV transmission in the future.

AB - Aim: To evaluate the cost-effectiveness of needle and syringe programmes (NSPs) compared to no NSPs on hepatitis C virus (HCV) transmission in the United Kingdom. Design: Cost-effectiveness analysis from NHS/ health-provider perspective, utilising a dynamic transmission model of HCV infection and disease progression, calibrated using city-specific surveillance and survey data, and primary data collection on NSP costs. The effectiveness of NSPs preventing HCV acquisition was based on empirical evidence. Setting: UK settings with different chronic HCV prevalence among people who inject drugs (PWID): Dundee (26%), Walsall (18%), and Bristol (45%) Population: PWID Interventions: Current NSP provision is compared to a counterfactual scenario where NSPs are removed for 10 years and then returned to existing levels with effects collected for 40 years. Measurements: HCV infections, and cost per quality adjusted life year (QALY) gained through NSPs over 50 years Findings: Compared to a willingness-to-pay threshold of £20,000 per QALY gained, NSPs were highly cost-effective over a time-horizon of 50 years and decreased the number of HCV incident infections. The mean incremental cost-effectiveness ratio was cost-saving in Dundee and Bristol, and £596 per QALY gained in Walsall, with 78%, 46% and 40% of simulations being cost-saving in each city, respectively, with differences driven by coverage of NSP and HCV prevalence (lowest in Walsall). Over 90% of simulations were cost-effective at the willingness-to-pay threshold. Results were robust to sensitivity analyses including varying the time-horizon, HCV treatment cost and numbers of HCV treatments per year. Conclusions: We projected NSPs avert HCV infections and are highly cost-effective in the UK and could be cost-saving to the NHS and other health care providers. NSPs will remain cost-effective in the UK irrespective of changes in HCV treatment cost and scale-up, meaning that NSPs will continue to be an efficient strategy for preventing HCV transmission in the future.

KW - Harm reduction

KW - mathematical modelling

KW - needle exchange

KW - injection drug use

KW - hepatitis C virus

KW - health economics

U2 - 10.1111/add.14519

DO - 10.1111/add.14519

M3 - Article (Academic Journal)

C2 - 30674091

SN - 0965-2140

VL - 114

SP - 560

EP - 570

JO - Addiction

JF - Addiction

IS - 3

ER -

Evaluating the cost-effectiveness of existing needle and syringe programmes in preventing Hepatitis C transmission in people who inject drugs

Abstract

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Keywords

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