Cost-Effectiveness of Scaling Up HCV Prevention, Testing and Treatment Interventions among People who Inject Drugs in the US

Author: Fraser H, Barbosa C, Vellozzi C, Hoerger TJ, Evans J, Hariri S, Havens J, Martin NK, Hickman M, Kral AH, Leib A, Nerlander L, Handanagic S, Raymond HF, Page K, Young A, Zibbell J, Ward J, Vickerman P

Theme: Epidemiology & Public Health Research Year: 2017

Background: HCV prevention and treatment interventions need scaling-up among people who inject drugs (PWID) to tackle the increasing HCV epidemic in the US; we undertake the first cost-effectiveness of this strategy.

Methods: We calibrated two HCV-transmission and disease progression models among PWID and ex-PWID to data from rural Perry County, Kentucky (PC) and urban San Francisco (SF). Compared to PC, SF has a greater proportion with recent (last 3-6 months) access to MAT (6%vs12%) or SSP (0%vs85%); both are assumed to reduce HCV-transmission risk by about 50%, and 70% combined. HCV-treatment of PWID is currently negligible in both settings. Intervention scenarios considered: (HR) Scale-up of SSP and MAT to 50% coverage (SSP coverage at baseline is high in SF) with no HCV-treatment scale-up; and HR (50% coverage for both) plus 90% of PWID HCV-screened annually and 90% of HCV-infected PWID treated annually. Using a health-care perspective and measuring benefits in terms of quality adjusted life years (QALYs), we determined the incremental cost-effectiveness ratio (ICER) of each intervention compared to existing baseline.

Results: In PC, intervention HR cost $14 million, gained 752 QALYs, for an ICER of $18,277 per QALY gained, whereas HR+PWID HCV-treatment cost $32 million, gained 3,143 QALYs, for an ICER of $10,157 per QALY gained. Conversely, the interventions were less cost-effective in SF; HR cost $367 million, gained 7,695 QALYs, for an ICER of $47,638 per QALY gained, whereas HR+PWID HCV-treatment cost $1,449 million, gained 71,441 QALYs, for an ICER of $20,288 per QALY gained. Assuming a $50,000 willingness to pay threshold, both interventions are cost-effective in 100% of simulations for PC, but in SF, only for 72% of simulations for HR and 100% for HR+PWID HCV-treatment.

Conclusion: The scale-up of HCV prevention, screening and treatment interventions for PWID could be cost-effective in rural and urban US settings.

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