Cost-effectiveness of scaling-up HCV prevention and treatment in the United States for people who inject drugs.
Antiviral Agents
/ economics
Cost-Benefit Analysis
Diagnostic Screening Programs
/ economics
Hepatitis C
/ economics
Humans
Kentucky
/ epidemiology
Models, Economic
Needle-Exchange Programs
/ economics
Opiate Substitution Treatment
/ economics
Rural Population
San Francisco
/ epidemiology
Substance Abuse, Intravenous
/ economics
Urban Population
Cost-effectiveness analysis
direct-acting antiviral HCV treatment
hepatitis C
medication-assisted treatment
opioid modeling
people who inject drugs
syringe-service programs
Journal
Addiction (Abingdon, England)
ISSN: 1360-0443
Titre abrégé: Addiction
Pays: England
ID NLM: 9304118
Informations de publication
Date de publication:
12 2019
12 2019
Historique:
received:
09
08
2018
revised:
19
12
2018
accepted:
28
06
2019
pubmed:
16
7
2019
medline:
20
11
2020
entrez:
16
7
2019
Statut:
ppublish
Résumé
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. HCV transmission and disease progression models with cost-effectiveness analysis using a health-care perspective. 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. 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. 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. Incremental cost-effectiveness ratios (ICERs) and uncertainty using cost-effectiveness acceptability curves. Benefits were measured in quality-adjusted life-years (QALYs). 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. 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.
Identifiants
pubmed: 31307116
doi: 10.1111/add.14731
pmc: PMC7751348
mid: NIHMS1654468
doi:
Substances chimiques
Antiviral Agents
0
Types de publication
Journal Article
Research Support, U.S. Gov't, P.H.S.
Langues
eng
Sous-ensembles de citation
IM
Pagination
2267-2278Subventions
Organisme : NIDA NIH HHS
ID : R01 DA024598
Pays : United States
Organisme : CDC HHS
ID : 200-2013-M-53964B GS-10F-0097L
Pays : United States
Organisme : NIDA NIH HHS
ID : R01 DA016017
Pays : United States
Organisme : NCATS NIH HHS
ID : UL1 TR001449
Pays : United States
Organisme : NIDA NIH HHS
ID : R01 DA033862
Pays : United States
Organisme : NIDA NIH HHS
ID : R01 DA037773
Pays : United States
Commentaires et corrections
Type : CommentIn
Informations de copyright
© 2019 Society for the Study of Addiction.
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