Abstract

People who inject drugs (PWID) are at high risk of hepatitis C virus (HCV) infection; however, ~50% are undiagnosed in England and linkage-to-care is poor. This study investigated the cost-effectiveness of an intervention (HepCATT) to improve case-finding and referral to HCV treatment compared with standard-of-care pathways in drug treatment centres in England. HCV transmission and disease progression model with cost-effectiveness analysis using a health-care perspective. Primary outcome and cost data from the HepCATT study parameterized the intervention, suggesting that HepCATT increased HCV testing in drug treatment centres 2.5-fold and engagement onto the HCV treatment pathway 10-fold. A model was used to estimate the decrease in HCV infections and HCV-related deaths from 2016, with costs and health benefits (quality-adjusted life-years or QALYs) tracked over 50years. Univariable and probabilistic sensitivity analyses (PSA) were undertaken. England-specific epidemic with 40% prevalence of chronic HCV among PWID. PWID attending drug treatment centres. Nurse facilitator in drug treatment centres to improve the HCV care pathway from HCV case-finding to referral and linkage to specialist care. Comparator was the standard-of-care HCV care pathway. Incremental cost-effectiveness ratio (ICER) in terms of cost per QALY gained through improved case-finding. Over 50years per 1000 PWID, the HepCATT intervention could prevent 75 (95% central interval 37-129) deaths and 1330 (827-2040) or 51% (30-67%) of all new infections. The mean ICER was £7986 per QALY gained, with all PSA simulations being cost-effective at a £20 000 per QALY willingness-to-pay threshold. Univariable sensitivity analyses suggest the intervention would become cost-saving if the cost of HCV treatment reduces to £3900. If scaled up to all PWID in England, the intervention would cost £8.8 million and decrease incidence by 56% (33-70%) by 2030. Increasing hepatitis C virus infection case-finding and treatment referral in drug treatment centres could be a highly cost-effective strategy for decreasing hepatitis C virus incidence among people who inject drugs.

Highlights

  • Infection with hepatitis C Virus (HCV) infection causes considerable morbidity[1]

  • Personal Social Services include services not normally covered by the National Health Service (NHS)[20], including drug treatment services and the Hepatitis C Awareness Through to Treatment study (HepCATT) intervention being evaluated in this analysis

  • Introducing a nurse led intervention to improve the Hepatitis C virus (HCV) testing and engagement to care of People who inject drugs (PWID) attending drug treatment centres is cost-effective (£7,986 per QALY saved) at current list prices for direct acting antiviral treatments (DAAs) HCV treatment (£39,000 per treatment), and becomes costsaving if drug costs decrease to £3,900 per treatment

Read more

Summary

Introduction

Infection with hepatitis C Virus (HCV) infection causes considerable morbidity[1]. People who inject drugs (PWID) are at high risk of Hepatitis C virus (HCV) infection; ~50% are undiagnosed in England and linkage-to-care is poor. This study investigated the cost-effectiveness of an intervention (HepCATT) to improve casefinding and referral to HCV treatment compared with standard-of-care pathways in drug treatment centres (DTCs) in England. Participants: PWID attending DTCs. Intervention: Nurse facilitator in DTCs to improve the HCV care pathway from HCV casefinding to referral and linkage to specialist care. Univariable sensitivity analyses suggest the intervention would become cost-saving if the cost of HCV treatment reduces to £3,900. Conclusions: Increasing Hepatitis C virus (HCV) infection case-finding and treatment referral in drug treatment centres could be a highly cost-effective strategy for decreasing HCV incidence among people who inject drugs

Methods
Results
Discussion
Conclusion
Full Text
Paper version not known

Talk to us

Join us for a 30 min session where you can share your feedback and ask us any queries you have

Schedule a call

Disclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.