Abstract
Background
HCV disproportionately affects marginalised communities such as homeless populations and people who inject drugs (PWID), posing a challenge to traditional health services. The HepFriend initiative in London is a model of care utilising HCV outreach screening and peer support to link vulnerable individuals to HCV treatment in secondary care.
Objective
Assess the cost-effectiveness of the HepFriend initiative from a healthcare provider perspective, compared to standard-of-care pathways (consisting of testing in primary care and other static locations, including drug treatment centres, and linkage to secondary care).
Methods
Cost-effectiveness analysis using a dynamic HCV transmission and disease progression model among PWID and those who have ceased injecting, including housing status and drug treatment service contact, parameterised using London specific surveillance and survey data, and primary intervention cost and effectiveness data (September 2015 to June 2018). Out of 461 individuals screened, 197 were identified as HCV RNA positive, 180 attended secondary care and 89 have commenced treatment to date. The incremental cost-effectiveness ratio (ICER) was determined using a 50-year time horizon.
Results
For a £20,000 per QALY gained willingness-to-pay threshold, the HepFriend initiative is cost-effective, mean ICER of £9,408/QALY, and would become cost-saving at 27% (£10,525 per treatment) of the current drug list price. Results are robust to variations in intervention costs and model assumptions, and if treatment rates are doubled the intervention becomes more cost-effective (£8,853/QALY).
Conclusion
New models of care that undertake active case-finding with enhanced peer-support to improve testing and treatment uptake amongst marginalised and vulnerable groups could be highly cost-effective and possibly cost-saving.
HCV disproportionately affects marginalised communities such as homeless populations and people who inject drugs (PWID), posing a challenge to traditional health services. The HepFriend initiative in London is a model of care utilising HCV outreach screening and peer support to link vulnerable individuals to HCV treatment in secondary care.
Objective
Assess the cost-effectiveness of the HepFriend initiative from a healthcare provider perspective, compared to standard-of-care pathways (consisting of testing in primary care and other static locations, including drug treatment centres, and linkage to secondary care).
Methods
Cost-effectiveness analysis using a dynamic HCV transmission and disease progression model among PWID and those who have ceased injecting, including housing status and drug treatment service contact, parameterised using London specific surveillance and survey data, and primary intervention cost and effectiveness data (September 2015 to June 2018). Out of 461 individuals screened, 197 were identified as HCV RNA positive, 180 attended secondary care and 89 have commenced treatment to date. The incremental cost-effectiveness ratio (ICER) was determined using a 50-year time horizon.
Results
For a £20,000 per QALY gained willingness-to-pay threshold, the HepFriend initiative is cost-effective, mean ICER of £9,408/QALY, and would become cost-saving at 27% (£10,525 per treatment) of the current drug list price. Results are robust to variations in intervention costs and model assumptions, and if treatment rates are doubled the intervention becomes more cost-effective (£8,853/QALY).
Conclusion
New models of care that undertake active case-finding with enhanced peer-support to improve testing and treatment uptake amongst marginalised and vulnerable groups could be highly cost-effective and possibly cost-saving.
| Original language | English |
|---|---|
| Article number | dkz451 |
| Pages (from-to) | v5-v16 |
| Number of pages | 12 |
| Journal | Journal of Antimicrobial Chemotherapy |
| Volume | 74 |
| Issue number | Suppl 5 |
| DOIs | |
| Publication status | Published - 29 Nov 2019 |