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Assessing the cost‐effectiveness of treating chronic hepatitis C virus in people who inject drugs in A ustralia
Author(s) -
Visconti Adam J,
Doyle Joseph S,
Weir Amanda,
Shiell Alan M,
Hellard Margaret E
Publication year - 2013
Publication title -
journal of gastroenterology and hepatology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.214
H-Index - 130
eISSN - 1440-1746
pISSN - 0815-9319
DOI - 10.1111/jgh.12041
Subject(s) - medicine , cost effectiveness , ribavirin , pegylated interferon , quality adjusted life year , cohort , hepatitis c , confidence interval , hepatitis c virus , chronic hepatitis , immunology , virus , risk analysis (engineering)
Background and Aim To assess the cost‐effectiveness of hepatitis C virus treatment with pegylated interferon alfa‐2a and ribavirin in current and former people who inject drugs ( PWID ). Methods A decision analytic model simulated the lifetime costs and outcomes of four treatment options: early treatment with mild fibrosis, standard treatment with moderate fibrosis, late treatment with compensated cirrhosis, and no treatment. Treatment modalities were simulated across current, former, and never‐injector cohorts of 1000 hypothetical patients with chronic hepatitis C virus. The main outcome measures were incremental costs ($ AUD ) per quality‐adjusted life years ( QALYs ) gained, and incremental cost‐effectiveness ratios ( ICERs ) were calculated for each cohort. Results Treatment of current PWID during mild fibrosis resulted in a discounted average gain of 1.60 QALYs (95% confidence interval 0.93–2.26) for an added cost of $12 723 ($11 153–$14 396) compared with no treatment, yielding an ICER of $7941 per QALY gained ($6347–$12 017). Former PWID gained 1.80 QALYs (1.29–2.33) for $10 441 ($8843–$12 074) for early treatment compared with no treatment, resulting in an ICER of $5808 per QALY gained ($5189–$6849). Never‐injectors gained 2.33 QALYs (1.87–2.80) for $9290 ($7642–$10 912) compared with no treatment—an ICER of $3985 per QALY gained ($3896–$4080). Early treatment was more cost‐effective than late treatment in all cohorts. Conclusions Despite comorbidities, increased mortality, and reduced adherence, treatment of both current and former PWID is cost‐effective. Our estimates fall below the unofficial Australian cost‐effectiveness threshold of $ AUD 50 000 per QALY for public subsidies. Scaling up treatment for PWID can be justified on purely economic grounds.