Table 1.
Studies modelling the cost-effectiveness of antiviral therapy for hepatitis C virus infection in people who inject drugs (PWID)
| Reference | Country/setting | Design | Intervention and population | Cost impact |
|---|---|---|---|---|
| PegIFN/RBV therapy | ||||
| Martin et al. 2012 [70] | United Kingdom | Dynamic disease progression and transmission model | pegIFN/RBV at mild stage vs no treatment (best supportive care) in: | ICER for treating current PWID vs no treatment, according to baseline chronic HCV prevalence: |
| Probablistic cost-utility analysis | Current PWID | 20 % prevalence: ICER treat PWID vs no treatment = £521/QALY | ||
| Direct medical costs (2010 prices) | Non/ex PWID | 40 % prevalence: ICER vs no treatment = £2539/QALY | ||
| N = 1000 individuals | 60 % prevalence: ICER = £7675a/QALY | |||
| Treatment of non/ex-PWID dominant at 60 % prevalence; ICER £6803/QALY vs no treatment | ||||
| Visconti et al. 2013 [71] | Australia | Markov decision-analytic model | pegIFN/RBV at mild (F0/1) stage vs no treatment (best supportive care) in: | Current PWID: $AUS 7941/QALY |
| Direct medical costs (2011 prices) | Current PWID | Former PWID: $AUS 5808/QALY | ||
| Former PWID | Non-injectors: $AUS 3985/QALY | |||
| Non-injectors | Treatment at mild stage dominated treatment at later stages for all cohorts | |||
| N = 1000 individuals | ||||
| DAA therapy | ||||
| Bennett et al. 2015 [58] | United Kingdom | Dynamic model of disease progression, transmission and treatment | Uptake increased to 250 per 1000 PWID of: | 2015–2027 |
| Current treatment | Current treatment: £23.4 million saved (£5.4 after discounting) | |||
| New DAA (SVR90%) | SVR90%: £36.3 million saved (£8.4 million after discounting) | |||
| Lifetime complication rates, costs of complications | N = 4240 individuals | |||
| Hellard et al. 2015 [72] | Australia | Closed compartmental model of disease progression and treatment | IFN-free DAA at | Late treatment vs no treatment: $AUS5078 |
| Early stage (from F0) | Early treatment vs late treatment: $AUS17,090 | |||
| Fixed rate of re-infection | Late-stage (from F2/3) | |||
| Direct healthcare costs (2014 prices) | N = 1000 individuals | |||
| Scott et al. 2016 [73] | Australia | Open compartmental model of progression, transmission and treatment | DAA treatment scale up necessary to achieve WHO goals of 65 % reduction in HCV-related deaths and 80 % reduction in HCV incidence by 2030 via two scenarios if DAA treatment for IDU-acquired HCV prioritised to: Patients with advanced liver disease (F ≥ 3) or Current PWID | Prioritising advanced liver disease: Mortality target required 5662 (95 % CI 5202–6901) courses/year (30/1000 IDU-acquired infections) |
| Prioritising PWID: | ||||
| Incidence and mortality targets achieved with 4725 (95 % CI 3278–8420) courses per year (59/1000 PWID) | ||||
| Additional 5564 (1959–6917) treatments/year (30/1000 IDU-acquired infections) required for 5 years for patients with advanced liver disease to avoid excess HCV-related deaths | ||||
| ICER: $AUS25,121 ($AUS11,062–$AUS39,036)/QALY | ||||
DAA direct acting agents, F0–3 METAVIR score, ICER incremental cost-effectiveness ratio, pegIFN/RBV peglyated interferon/ribavirin, QALY quality-adjusted life-years, SVR sustained virological response
aCalculated from data in published source