Eradicating Hepatitis C: are novel screening strategies for people who inject drugs cost-effective?

Manca, F., Robinson, E., Dillon, J. F. and Boyd, K. A. (2020) Eradicating Hepatitis C: are novel screening strategies for people who inject drugs cost-effective? International Journal of Drug Policy, 82, 102811. (doi: 10.1016/j.drugpo.2020.102811) (PMID:32585583)

Abstract

Background: In developed countries, people who inject drugs (PWID) have a high prevalence of hepatitis C virus (HCV), yet they are often under-diagnosed. The World Health Organization has set 2030 as a target year for HCV elimination. To meet this target, improving screening in convenient community settings in order to reach infected undiagnosed individuals is a priority. This study assesses the cost-effectiveness of alternative novel strategies for diagnosing HCV infection in PWID. Methods: A cost-effectiveness analysis was undertaken to compare HCV screening at needle exchange centres, substance misuse services and at community pharmacies, with the standard practice of detection during general practitioners’ consultations. A decision tree model was developed to assess the incremental cost per positive diagnosis, and a Markov model explored the net monetary benefit (NMB) and the cost per Quality Adjusted Life Years (QALYs) gained over a lifetime horizon. Results: Needle exchange services provided a 7.45-fold increase in detecting positive individuals and an incremental cost of £12,336 per QALY gained against current practice (NMB £163,827), making this the most cost-effective strategy over a lifetime horizon. Screening at substance misuse services and pharmacies was cost-effective only at a £30,000/QALY threshold. With a 24% discount to HCV treatment list prices, all three screening strategies become cost-effective at £20,000/QALY. Conclusions: Targeting PWID populations with screening at needle exchange services is a highly cost-effective strategy for reaching undiagnosed HCV patients. When applying realistic discounts to list prices of drug treatments, all three strategies were highly cost-effective from a UK NHS perspective. All of these strategies have the potential to make a cost-effective contribution to the eradication of HCV by 2030.

• Item Type: Articles
• Additional Information: This work was supported by an Investigator Sponsored Research (ISR) project grant from Gilead Sciences Inc.
• Status: Published
• Refereed: Yes
• Glasgow Author(s) Enlighten ID: Boyd, Professor Kathleen and Manca, Mr Francesco
• Authors: Manca, F., Robinson, E., Dillon, J. F., and Boyd, K. A.
• College/School: College of Medical Veterinary and Life Sciences > School of Health & Wellbeing > Health Economics and Health Technology Assessment
• Journal Name: International Journal of Drug Policy
• Publisher: Elsevier
• ISSN: 0955-3959
• ISSN (Online): 1873-4758
• Published Online: 22 June 2020
• Copyright Holders: Copyright © 2020 The Authors
• First Published: First published in International Journal of Drug Policy 82:102811
• Publisher Policy: Reproduced under a Creative Commons License