Cost-effectiveness of scaling-up HCV prevention and treatment in the United States for people who inject drugs.
Open accessAbstract
AIMS: 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. DESIGN: HCV transmission and disease progression models with cost-effectiveness analysis using a health-care perspective. SETTING: 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. PARTICIPANTS: 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. INTERVENTIONS AND COMPARATOR: 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. MEASUREMENTS: Incremental cost-effectiveness ratios (ICERs) and uncertainty using cost-effectiveness acceptability curves. Benefits were measured in quality-adjusted life-years (QALYs). FINDINGS: 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. CONCLUSIONS: 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.
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Regular screening of persons with HIV for HCV is cost-effective.
“Because acute HCV infection acquisition among persons with HIV infection can occur, especially among MSM, and regular screening of those with HIV is cost-effective (238,239,1377), periodic HCV screening should be conducted (1378–1380).”
From Sexually Transmitted Infections Treatment Guidelines, 2021 (2021) · cites this paper as [1377]
The Methods (Intervention Scenarios; page unavailable) describe annual HCV screening for people who inject drugs, and the Discussion (page unavailable) finds the combined screening, treatment, and prevention intervention cost-effective. The paper does not establish that regular screening of persons with HIV, as a group, is cost-effective. (LLM, conf=0.86)
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Sexually Transmitted Infections Treatment Guidelines, 2021
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- Authors
- Barbosa, C., Fraser, H., Hoerger, T. J., Leib, A., Havens, J. R., Young, A., Kral, A., Page, K., Evans, J., Zibbell, J., Hariri, S., Vellozzi, C., Nerlander, L., Ward, J. W., & Vickerman, P.
- Affiliations
- RTI International (US)
- University of Bristol (GB)
- University of Colorado Denver (US)
- University of Kentucky (US)
- University of New Mexico (US)
- University of California, San Francisco (US)
- Centers for Disease Control and Prevention (US)
- Grady Health System (US)
- Corresponding author
- Barbosa, Carolina
- ORCID
- Venue
- Addiction
- Publisher
- Wiley
- Published
- 2019-08-02
- Volume
- 114
- Issue
- 12
- Pages
- 2267-2278
- ISSN
- 0965-2140 (ISSN-L)
- 1360-0443
- PMC
- PMC7751348
- OpenAlex
- W2959900172
- Cited by
- 48
- References
- 74
- Citations by year
- 2026: 3 · 2025: 5 · 2024: 9 · 2023: 9 · 2022: 3 · 2021: 13 · 2020: 5 · 2019: 1
- FWCI
- 4.19
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Licence
- Locations
- Addiction (publishedVersion)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion)
- Bristol Research (University of Bristol) (submittedVersion, other-oa)
- Funders
- Centers for Disease Control and Prevention (200‐2013‐M‐53964B GS‐10F‐0097L)
- Topics
- Health Sciences › Medicine › Epidemiology › HIV, Drug Use, Sexual Risk
- Health Sciences › Medicine › Hepatology › Hepatitis C virus research
- Social Sciences › Economics, Econometrics and Finance › Economics and Econometrics › Health Systems, Economic Evaluations, Quality of Life
- Keywords
- hepatitis C, people who inject drugs, cost-effectiveness, syringe services programs, medication-assisted treatment, HCV screening, direct-acting antivirals, HCV prevention, quality-adjusted life years, Perry County, Kentucky, San Francisco
- MeSH terms
- Diagnostic Screening Programs, Antiviral Agents, Cost-Benefit Analysis, Hepatitis C, Humans, Kentucky, Rural Population, San Francisco, Urban Population, Substance Abuse, Intravenous, Needle-Exchange Programs, Models, Economic, Opiate Substitution Treatment
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