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 contribution | The cost-effectiveness of HCV antiviral treatment for injecting drug user populations |
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Original language | English |
Pages (from-to) | 49-57 |
Number of pages | 9 |
Journal | Hepatology |
Volume | 55 |
Issue number | 1 |
Early online date | 6 Dec 2011 |
DOIs | |
Publication status | Published - 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