The cost-effectiveness of case-finding strategies for achieving hepatitis C elimination among men who have sex with men in the UK

Louis Macgregor*, Zoe Ward, Natasha K Martin, Jane Nicholls, Monica Desai, Ford Hickson, Peter Weatherburn, Matthew Hickman, Peter Vickerman*

*Corresponding author for this work

Research output: Contribution to journalArticle (Academic Journal)peer-review

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Abstract

Modelling suggests hepatitis C virus (HCV) elimination is possible among men who have sex with men (MSM), with key screening groups including HIV-diagnosed MSM and MSM using pre-exposure prophylaxis (PrEP). Mathematical modelling was used to determine the cost-effectiveness of HCV case-finding strategies among MSM from the provider perspective, and to determine which interventions could achieve a 90% reduction in HCV incidence over 2015-2030. At baseline, we assumed symptomatic screening in HIV-negative MSM (including PrEP users) and 12-monthly screening among HIV-diagnosed MSM. Improved case-finding strategies included screening alongside HIV testing in HIV-negative MSM not using PrEP (PrEP non-users); 12/6/3-monthly screening in PrEP users; and 6-monthly screening in HIV-diagnosed MSM, with the cost-effectiveness being compared incrementally. Costs (GBP) and quality-adjusted life years (QALYs) were assessed to estimate the mean incremental cost-effectiveness ratio (ICER) with a time horizon to 2050, compared to a willingness-to-pay threshold of £20,000/QALY. From the baseline, the most incrementally cost-effective strategy is to firstly undertake: (1) 12-monthly HCV screening of PrEP users (gaining 6715 QALYs with ICER £1760/QALY), followed by (2) HCV screening among PrEP non-users alongside HIV testing (gaining 7048 QALYs with ICER £4972/QALY). Compared to the baseline, this combined strategy would cost £46.9 (95%CrI £25.3-£66.9) million and achieve the HCV elimination target in 100% of model runs. Additional screening incurs ICERs >£20,000/QALY compared to this combined strategy. In conclusion, HCV elimination can be achieved cost-effectively among UK MSM. Policymakers should consider scaling-up HCV screening in HIV-negative MSM, especially PrEP users, for achieving this target.

Original languageEnglish
Pages (from-to)897-908
Number of pages12
JournalJournal of Viral Hepatitis
Volume28
Issue number6
Early online date1 Apr 2021
DOIs
Publication statusPublished - Jun 2021

Bibliographical note

Funding Information:
This work was supported by the ESPRC, via grant for the PhD studies of Louis MacGregor; MH and PV would also like to acknowledge support from the NIHR funded Health Protection Research Unit in Evaluation of Interventions and Behavioural Science. PV would also like to acknowledge the NIHR funded Health Protection Research Unit in STIs and BBVs. NM and PV were supported by the National Institute for Allergy and Infectious Diseases and National Institute for Drug Abuse [grant number R01AI147490]. NM additionally was supported by the University of California San Diego Center for AIDS Research (CFAR), a National Institute of Health (NIH) funded program [grant number P30 AI036214].

Publisher Copyright:
© 2021 The Authors. Journal of Viral Hepatitis published by John Wiley & Sons Ltd.

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