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The cost-effectiveness of an HCV outreach intervention for at-risk populations in London, UK.

Research output: Contribution to journalSpecial issue

Original languageEnglish
Article numberdkz451
Pages (from-to)v5-v16
Number of pages12
JournalJournal of Antimicrobial Chemotherapy
Volume74
Issue numberSuppl 5
DOIs
DateAccepted/In press - 6 Sep 2019
DatePublished (current) - 29 Nov 2019

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.

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    Rights statement: This is the final published version of the article (version of record). It first appeared online via Oxford University Press at https://academic.oup.com/jac/article/74/Supplement_5/v5/5645641 . Please refer to any applicable terms of use of the publisher.

    Final published version, 368 KB, PDF document

    Licence: CC BY-NC

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