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Cost‐effectiveness of the HepCATT intervention in specialist drug clinics to improve case‐finding and engagement with HCV treatment for people who inject drugs in England
Author(s) -
Ward Zoe,
Reynolds Rosie,
Campbell Linda,
Martin Natasha K.,
Harrison Graham,
Irving William,
Hickman Matthew,
Vickerman Peter
Publication year - 2020
Publication title -
addiction
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.424
H-Index - 193
eISSN - 1360-0443
pISSN - 0965-2140
DOI - 10.1111/add.14978
Subject(s) - medicine , hepatitis c , hepatitis c virus , referral , cost effectiveness , family medicine , emergency medicine , immunology , virus , risk analysis (engineering)
Background and Aims 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. Design 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 50 years. Univariable and probabilistic sensitivity analyses (PSA) were undertaken. Setting England‐specific epidemic with 40% prevalence of chronic HCV among PWID. Participants PWID attending drug treatment centres. Intervention 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. Measurements Incremental cost‐effectiveness ratio (ICER) in terms of cost per QALY gained through improved case‐finding. Findings Over 50 years 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. Conclusions 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.