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

Author: Ward Z, Campbell L, Surey J, Platts S, Glass R, Hickman M, Story A, Vickerman P

Theme: Epidemiology & Public Health Research Year: 2019

Background: Hepatitis C virus (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.
The objective was to 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 quality adjusted life year (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 background 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.
Disclose of interest: none

Download abstract