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Cost-effectiveness of scaling-up HCV prevention and treatment in the United States for people who inject drugs.
Addiction 2019A

Abstract

AIMS

To examine the cost-effectiveness of hepatitis C virus (HCV) treatment of people who inject drugs (PWID), combined with medication-assisted treatment (MAT) and syringe-service programs (SSP), to tackle the increasing HCV epidemic in the United States.

DESIGN

HCV transmission and disease progression models with cost-effectiveness analysis using a health-care perspective.

SETTING

Rural Perry County, KY (PC) and urban San Francisco, CA (SF), USA. Compared with PC, SF has a greater proportion of PWID with access to MAT or SSP. HCV treatment of PWID is negligible in both settings.

PARTICIPANTS

PWID data were collected between 1998 and 2015 from Social Networks Among Appalachian People, U Find Out, Urban Health Study and National HIV Behavioral Surveillance System studies.

INTERVENTIONS AND COMPARATOR

Three intervention scenarios modeled: baseline-existing SSP and MAT coverage with HCV screening and treatment with direct-acting antiviral for ex-injectors only as per standard of care; intervention 1-scale-up of SSP and MAT without changes to treatment; and intervention 2-scale-up as intervention 1 combined with HCV screening and treatment for current PWID.

MEASUREMENTS

Incremental cost-effectiveness ratios (ICERs) and uncertainty using cost-effectiveness acceptability curves. Benefits were measured in quality-adjusted life-years (QALYs).

FINDINGS

For both settings, intervention 2 is preferred to intervention 1 and the appropriate comparator for intervention 2 is the baseline scenario. Relative to baseline, for PC intervention 2 averts 1852 more HCV infections, increases QALYS by 3095, costs $21.6 million more and has an ICER of $6975/QALY. For SF, intervention 2 averts 36 473 more HCV infections, increases QALYs by 7893, costs $872 million more and has an ICER of $11 044/QALY. The cost-effectiveness of intervention 2 was robust to several sensitivity analysis.

CONCLUSIONS

Hepatitis C screening and treatment for people who inject drugs, combined with medication-assisted treatment and syringe-service programs, is a cost-effective strategy for reducing hepatitis C burden in the United States.

Authors+Show Affiliations

RTI International, Research Triangle Park, NC, USA.University of Bristol, Bristol, UK.RTI International, Research Triangle Park, NC, USA.Department of Chemistry, University of Colorado, Denver, USA.College of Medicine, University of Kentucky, Lexington, KY, USA.College of Medicine, University of Kentucky, Lexington, KY, USA.RTI International, Research Triangle Park, NC, USA.Health Sciences Center, University of New Mexico, Albuquerque, NM, USA.Univerisity of California, San Francisco, CA, USA.RTI International, Research Triangle Park, NC, USA.Centers for Disease Control and Prevention, Atlanta, GA, USA.Grady Health System, Atlanta, GA, USA.Centers for Disease Control and Prevention, Atlanta, GA, USA.Centers for Disease Control and Prevention, Atlanta, GA, USA.University of Bristol, Bristol, UK.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

31307116

Citation

Barbosa, Carolina, et al. "Cost-effectiveness of Scaling-up HCV Prevention and Treatment in the United States for People Who Inject Drugs." Addiction (Abingdon, England), 2019.
Barbosa C, Fraser H, Hoerger TJ, et al. Cost-effectiveness of scaling-up HCV prevention and treatment in the United States for people who inject drugs. Addiction. 2019.
Barbosa, C., Fraser, H., Hoerger, T. J., Leib, A., Havens, J. R., Young, A., ... Vickerman, P. (2019). Cost-effectiveness of scaling-up HCV prevention and treatment in the United States for people who inject drugs. Addiction (Abingdon, England), doi:10.1111/add.14731.
Barbosa C, et al. Cost-effectiveness of Scaling-up HCV Prevention and Treatment in the United States for People Who Inject Drugs. Addiction. 2019 Jul 15; PubMed PMID: 31307116.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Cost-effectiveness of scaling-up HCV prevention and treatment in the United States for people who inject drugs. AU - Barbosa,Carolina, AU - Fraser,Hannah, AU - Hoerger,Thomas J, AU - Leib,Alyssa, AU - Havens,Jennifer R, AU - Young,April, AU - Kral,Alex, AU - Page,Kimberly, AU - Evans,Jennifer, AU - Zibbell,Jon, AU - Hariri,Susan, AU - Vellozzi,Claudia, AU - Nerlander,Lina, AU - Ward,John W, AU - Vickerman,Peter, Y1 - 2019/07/15/ PY - 2018/08/09/received PY - 2018/12/19/revised PY - 2019/06/28/accepted PY - 2019/7/16/pubmed PY - 2019/7/16/medline PY - 2019/7/16/entrez KW - Cost-effectiveness analysis KW - direct-acting antiviral HCV treatment KW - hepatitis C KW - medication-assisted treatment KW - opioid modeling KW - people who inject drugs KW - syringe-service programs JF - Addiction (Abingdon, England) JO - Addiction N2 - AIMS: To examine the cost-effectiveness of hepatitis C virus (HCV) treatment of people who inject drugs (PWID), combined with medication-assisted treatment (MAT) and syringe-service programs (SSP), to tackle the increasing HCV epidemic in the United States. DESIGN: HCV transmission and disease progression models with cost-effectiveness analysis using a health-care perspective. SETTING: Rural Perry County, KY (PC) and urban San Francisco, CA (SF), USA. Compared with PC, SF has a greater proportion of PWID with access to MAT or SSP. HCV treatment of PWID is negligible in both settings. PARTICIPANTS: PWID data were collected between 1998 and 2015 from Social Networks Among Appalachian People, U Find Out, Urban Health Study and National HIV Behavioral Surveillance System studies. INTERVENTIONS AND COMPARATOR: Three intervention scenarios modeled: baseline-existing SSP and MAT coverage with HCV screening and treatment with direct-acting antiviral for ex-injectors only as per standard of care; intervention 1-scale-up of SSP and MAT without changes to treatment; and intervention 2-scale-up as intervention 1 combined with HCV screening and treatment for current PWID. MEASUREMENTS: Incremental cost-effectiveness ratios (ICERs) and uncertainty using cost-effectiveness acceptability curves. Benefits were measured in quality-adjusted life-years (QALYs). FINDINGS: For both settings, intervention 2 is preferred to intervention 1 and the appropriate comparator for intervention 2 is the baseline scenario. Relative to baseline, for PC intervention 2 averts 1852 more HCV infections, increases QALYS by 3095, costs $21.6 million more and has an ICER of $6975/QALY. For SF, intervention 2 averts 36 473 more HCV infections, increases QALYs by 7893, costs $872 million more and has an ICER of $11 044/QALY. The cost-effectiveness of intervention 2 was robust to several sensitivity analysis. CONCLUSIONS: Hepatitis C screening and treatment for people who inject drugs, combined with medication-assisted treatment and syringe-service programs, is a cost-effective strategy for reducing hepatitis C burden in the United States. SN - 1360-0443 UR - https://www.unboundmedicine.com/medline/citation/31307116/Cost-Effectiveness_of_Scaling_Up_HCV_Prevention_and_Treatment_in_the_United_States_for_People_Who_Inject_Drugs L2 - https://doi.org/10.1111/add.14731 DB - PRIME DP - Unbound Medicine ER -