The cost-effectiveness of hepatitis C virus antiviral treatment for injection drug user populations

Natasha K. Martin, Peter Vickerman, Alec Miners, Graham R. Foster, Sharon J. Hutchinson, David J. Goldberg, Matthew Hickman

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

165 Citations (Scopus)

Abstract

Injecting drug use is the main risk of hepatitis C virus (HCV) transmission in most developed countries. HCV antiviral treatment (peginterferon-a + ribavirin) has been shown to be cost-effective for patients with no reinfection risk. We examined the cost-effectiveness of providing antiviral treatment for injecting drug users (IDUs) as compared with treating ex/non-IDUs or no treatment. A dynamic model of HCV transmission and disease progression was developed, incorporating: a fixed number of antiviral treatments allocated at the mild HCV stage over 10 years, no retreatment after treatment failure, potential reinfection, and three baseline IDU HCV chronic prevalence scenarios (20%, 40%, and 60%). We performed a probabilistic cost-utility analysis estimating long-term costs and outcomes measured in quality adjusted life years (QALYs) and calculating the incremental cost-effectiveness ratio (ICER) comparing treating IDUs, ex/non-IDUs, or no treatment. Antiviral treatment for IDUs is the most cost-effective option in the 20% and 40% baseline chronic prevalence settings, with ICERs compared with no treatment of 521 pound and 2,539 pound per QALY saved, respectively. Treatment of ex/non-IDUs is dominated in these scenarios. At 60% baseline prevalence, treating ex/non-IDUs is slightly more likely to be the more cost-effective option (with an ICER compared with no treatment of 6,803) pound, and treating IDUs dominated due to high reinfection. A sensitivity analysis indicates these rankings hold even when IDU sustained viral response rates as compared with ex/non-IDUs are halved. Conclusion: Despite the possibility of reinfection, the model suggests providing antiviral treatment to IDUs is the most cost-effective policy option in chronic prevalence scenarios less than 60%. Further research on how HCV treatment for injectors can be scaled up and its impact on prevalence is warranted. (HEPATOLOGY 2012;2012;55:49-57)

Translated title of the contributionThe cost-effectiveness of HCV antiviral treatment for injecting drug user populations
Original languageEnglish
Pages (from-to)49-57
Number of pages9
JournalHepatology
Volume55
Issue number1
Early online date6 Dec 2011
DOIs
Publication statusPublished - Jan 2012

Bibliographical note

Copyright © 2011 American Association for the Study of Liver Diseases.

Keywords

  • Antiviral Agents
  • Cost-Benefit Analysis
  • Drug Costs
  • Great Britain
  • Hepatitis C, Chronic
  • Humans
  • Injections, Intravenous
  • Interferon-alpha
  • Needles
  • Polyethylene Glycols
  • Prevalence
  • Recurrence
  • Ribavirin
  • Risk Factors
  • Substance-Related Disorders
  • Syringes

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