Eradicating hepatitis C: Are novel screening strategies for people who inject drugs cost-effective?

Francesco Manca (Lead / Corresponding author), Emma Robinson (Lead / Corresponding author), John F. Dillon (Lead / Corresponding author), Kathleen Anne Boyd (Lead / Corresponding author)

    Research output: Contribution to journalArticlepeer-review

    8 Citations (Scopus)
    127 Downloads (Pure)

    Abstract

    Background: In developed countries, people who inject drugs (PWID) have a high prevalence of hepatitis C virus (HCV), yet they are often under-diagnosed. The World Health Organization has set 2030 as a target year for HCV elimination. To meet this target, improving screening in convenient community settings in order to reach infected undiagnosed individuals is a priority. This study assesses the cost-effectiveness of alternative novel strategies for diagnosing HCV infection in PWID. 

    Methods: A cost-effectiveness analysis was undertaken to compare HCV screening at needle exchange centres, substance misuse services and at community pharmacies, with the standard practice of detection during general practitioners’ consultations. A decision tree model was developed to assess the incremental cost per positive diagnosis, and a Markov model explored the net monetary benefit (NMB) and the cost per Quality Adjusted Life Years (QALYs) gained over a lifetime horizon.

    Results: Needle exchange services provided a 7.45-fold increase in detecting positive individuals and an incremental cost of £12,336 per QALY gained against current practice (NMB £163,827), making this the most cost-effective strategy over a lifetime horizon. Screening at substance misuse services and pharmacies was cost-effective only at a £30,000/QALY threshold. With a 24% discount to HCV treatment list prices, all three screening strategies become cost-effective at £20,000/QALY.

    Conclusions: Targeting PWID populations with screening at needle exchange services is a highly cost-effective strategy for reaching undiagnosed HCV patients. When applying realistic discounts to list prices of drug treatments, all three strategies were highly cost-effective from a UK NHS perspective. All of these strategies have the potential to make a cost-effective contribution to the eradication of HCV by 2030.

    Original languageEnglish
    Article number102811
    Number of pages10
    JournalInternational Journal of Drug Policy
    Volume82
    Early online date22 Jun 2020
    DOIs
    Publication statusPublished - Aug 2020

    Keywords

    • Direct acting antiviral
    • Economic analysis
    • Economic model
    • Hepatitis C virus
    • Needle exchange

    ASJC Scopus subject areas

    • Medicine (miscellaneous)
    • Health Policy

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