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

Francesco Manca; Emma Robinson; John F Dillon; Kathleen Anne Boyd

doi:10.1016/j.drugpo.2020.102811

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

Int J Drug Policy. 2020 Aug:82:102811. doi: 10.1016/j.drugpo.2020.102811. Epub 2020 Jun 22.

Authors

Francesco Manca¹, Emma Robinson², John F Dillon³, Kathleen Anne Boyd⁴

Affiliations

¹ Health Economics and Health Technology Assessment (HEHTA), Institute of Health and Wellbeing, University of Glasgow, 1 Lilybank Gardens, Glasgow G12 8RZ, UK. Electronic address: francesco.manca@glasgow.ac.uk.
² School of Medicine, University of Dundee, Ninewells hospital and Medical school, DD1 9SY Dundee, UK. Electronic address: e.robinson7@nhs.net.
³ School of Medicine, University of Dundee, Ninewells hospital and Medical school, DD1 9SY Dundee, UK. Electronic address: j.dillon@nhs.net.
⁴ Health Economics and Health Technology Assessment (HEHTA), Institute of Health and Wellbeing, University of Glasgow, 1 Lilybank Gardens, Glasgow G12 8RZ, UK. Electronic address: Kathleen.Boyd@glasgow.ac.uk.

PMID: 32585583
DOI: 10.1016/j.drugpo.2020.102811

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.

Keywords: Direct acting antiviral; Economic analysis; Economic model; Hepatitis C virus; Needle exchange.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Antiviral Agents / therapeutic use
Cost-Benefit Analysis
Hepacivirus
Hepatitis C* / diagnosis
Hepatitis C* / drug therapy
Humans
Mass Screening
Pharmaceutical Preparations*
Quality-Adjusted Life Years

Substances

Antiviral Agents
Pharmaceutical Preparations