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Cost‐effectiveness of hepatitis C virus antiviral treatment for injection drug user populations
Author(s) -
Martin Natasha K.,
Vickerman Peter,
Miners Alec,
Foster Graham R.,
Hutchinson Sharon J.,
Goldberg David J.,
Hickman Matthew
Publication year - 2012
Publication title -
hepatology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 5.488
H-Index - 361
eISSN - 1527-3350
pISSN - 0270-9139
DOI - 10.1002/hep.24656
Subject(s) - medicine , ribavirin , hepatitis c , antiviral treatment , transmission (telecommunications) , cost effectiveness , drug , hepatitis c virus , viral load , virology , immunology , chronic hepatitis , virus , pharmacology , risk analysis (engineering) , electrical engineering , engineering
Injecting drug use is the main risk of hepatitis C virus (HCV) transmission in most developed countries. HCV antiviral treatment (peginterferon‐α + ribavirin) has been shown to be cost‐effective for patients with no reinfection risk. We examined the cost‐effectiveness of providing antiviral treatment for injecting drug users (IDUs) as compared with treating ex/non‐IDUs or no treatment. A dynamic model of HCV transmission and disease progression was developed, incorporating: a fixed number of antiviral treatments allocated at the mild HCV stage over 10 years, no retreatment after treatment failure, potential reinfection, and three baseline IDU HCV chronic prevalence scenarios (20%, 40%, and 60%). We performed a probabilistic cost‐utility analysis estimating long‐term costs and outcomes measured in quality adjusted life years (QALYs) and calculating the incremental cost‐effectiveness ratio (ICER) comparing treating IDUs, ex/non‐IDUs, or no treatment. Antiviral treatment for IDUs is the most cost‐effective option in the 20% and 40% baseline chronic prevalence settings, with ICERs compared with no treatment of £521 and £2,539 per QALY saved, respectively. Treatment of ex/non‐IDUs is dominated in these scenarios. At 60% baseline prevalence, treating ex/non‐IDUs is slightly more likely to be the more cost‐effective option (with an ICER compared with no treatment of £6,803), and treating IDUs dominated due to high reinfection. A sensitivity analysis indicates these rankings hold even when IDU sustained viral response rates as compared with ex/non‐IDUs are halved. Conclusion : Despite the possibility of reinfection, the model suggests providing antiviral treatment to IDUs is the most cost‐effective policy option in chronic prevalence scenarios less than 60%. Further research on how HCV treatment for injectors can be scaled up and its impact on prevalence is warranted. (H EPATOLOGY 2012)