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P53 The cost-effectiveness of HCV antiviral treatment for injecting drug user populations
  1. N K Martin1,
  2. P Vickerman1,
  3. G R Foster2,
  4. A Miners3,
  5. S J Hutchinson4,
  6. D J Goldberg2,
  7. M Hickman5
  1. 1University of Bristol
  2. 2London School of Hygiene and Tropical Medicine
  3. 3Queen Marys University of London
  4. 4Barts and The London School of Medicine
  5. 5Health Protection Scotland

Abstract

Introduction Injecting drug use is the main risk of HCV transmission in most developed countries. Hepatitis C virus antiviral treatment (peginterferon + ribavirin) is cost-effective for patients with no reinfection risk. Concerns about reinfection and non-compliance may discourage clinicians from treating injecting drug users (IDUs), despite the potential use of treatment as prevention in this population.

Aim Using a cost-utility analysis, we examined the cost-effectiveness of providing antiviral treatment for IDUs as compared to treating ex/non-IDUs or no treatment.

Method A dynamic model of hepatitis C transmission and disease progression among IDUs and ex-/non-IDUs was developed, incorporating: a fixed number of antiviral treatments allocated at the mild HCV stage over 10 years, no retreatment after initial treatment failure, and potential re-infection for cured IDUs. We performed a probabilistic cost-utility analysis estimating long-term costs and outcomes (measured in QALYs) and calculating the incremental cost-effectiveness ratio (ICER) to determine the cost-effectiveness of treating IDUs as compared to treating ex/non-IDUs or no treatment for three baseline IDU HCV prevalence scenarios (20%, 40%, and 60%).

Results Antiviral treatment of IDUs is the most cost-effective option in both the 20% and 40% baseline chronic prevalence settings, with ICERs as compared to no treatment (best supportive care) of £521 and £2539 per QALY saved, respectively. Treatment of ex/non-IDUs is dominated in these scenarios. At 60% baseline prevalence, treatment of ex/non-IDUs or IDUs is roughly equally cost-effective; treating ex/non-IDUs is more likely to be the most cost-effective option (with an ICER as compared to no treatment of £6803), and treating IDUs is dominated due to the high re-infection at this prevalence. A sensitivity analysis indicates that these rankings hold even when IDU SVR rates as compared to ex/non-IDUs are halved.

Conclusion Despite the possibility of re-infection, the model projections suggest that providing antiviral treatment to IDUs is the most cost-effective policy option in chronic prevalence scenarios <60%. Further research on how HCV treatment for injectors can be scaled up, and its impact on prevalence is warranted.

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