Impact and cost-effectiveness of interventions to eliminate hepatitis C virus among people who inject drugs in Haiphong, Vietnam

Background & Aims
In Haiphong, Vietnam, most hepatitis C virus (HCV) infections occur among people who inject drugs
(PWID). As part of multiple respondent-driven sampling (RDS) surveys undertaken among PWID in
Haiphong, an intervention (DRIVE-C) provided HCV testing and treatment in 2019. Centres providing
opiate agonist treatment (OAT) or antiretroviral therapy (ART) also provided HCV testing and linkageto-treatment in 2021/22. We modelled the impact and cost-effectiveness of providing HCV testing
and treatment to PWID in Haiphong.

Methods
A HCV transmission model among PWID and former injectors was calibrated in a Bayesian framework
using data from Haiphong. A status quo (SQ) scenario modelled historical interventions, with no
future HCV treatment. A future intervention scenario modelled the additional impact of providing
HCV testing and linkage-to-treatment in OAT and ART centres, and annual RDS survey interventions
each testing 1400 PWID over 2025-2030. We estimated the incremental cost-effectiveness ratio
(ICER) per disability adjusted life-year (DALY) averted for the future scenario compared to SQ over
2025-2054 (3% annual discount).

Results
For the SQ scenario, HCV incidence decreased from 8.7 (95% credibility interval 5.3-13.9) per 100
person-years (/100pyrs) in 2015 to 5.1/100pyrs (3.0-8.2) in 2023 and 5.6/100pyrs (3.2-9.3) in 2030. In
the future intervention scenario, incidence decreases to 1.8/100pyrs (0.6-4.3) by 2030. The mean
ICER is €705/DALY averted; cost-effective at a willingness-to-pay threshold of €2,334 (50% of
Vietnam’s 2023 GDP per capita).

Conclusions
Using RDS surveys and other care settings to scale-up HCV-testing and treatment are cost-effective
strategies to reduce HCV incidence among PWID in Vietnam.