A cost-effectiveness analysis of an intervention to increase linkage to care of HCV-infected patients on opioid substitution therapy (HepLink Ireland)

Author: Ward Z, Mafirakureva N, Swan D, O’Connor E, Cullen W, Vickerman P

Theme: Epidemiology & Public Health Research Year: 2019

Background: In Ireland, HCV antibody (Ab+) prevalence among people on opioid substitution therapy (OST)
is high (62-81%), but only 3% are HCV-treated. The HepLink intervention (04/2016-07/2017) aimed to
increase numbers of HCV Ab+ patients linked to secondary care. We evaluated the cost-effectiveness of
HepLink compared to the current standard-of-care of antibody testing and referral by primary care
Method: A Markov model of HCV disease progression and treatment of the HepLink cohort (135 patients).
Pre-HepLink data suggested 6% of known chronically infected patients are treated per year at baseline.
Follow-up HepLink data was used to parameterize the intervention arm. The nurse saw 102 patients, 77
(76%) were known Ab+ and 57 were either unknown or positive chronic status. Of these, 43 (75%) were
fibroscanned and 10 (18%) started treatment during the intervention. Primary intervention cost data and
costs for HCV treatment were collected from interviews. Health benefits were measured in quality adjusted
life years (QALYs). The cost-effectiveness was estimated over a 50-year time-horizon for full (€39,729 per
course) and 25% of the full list price for HCV treatment with a 5% discount rate by calculating the
incremental cost-effectiveness ratio (ICER) and comparing it to Ireland’s willingness-to-pay (WTP) threshold
(€30,000 per QALY).
Results: Direct costs of the intervention were €186,249, with €213,450 extra in HCV treatments. Benefits
included €117,740 saved in HCV-related healthcare and 15 QALYs saved. HepLink is cost-effective with a
mean ICER of €17,227 per QALY at full drug costs, reducing to €8,306 per QALY at 25% of these drug costs
(90% and 99% chance below WTP threshold, respectively). Uncertainty in the background treatment rate
accounts for nearly all the variation in incremental costs and QALYs (90% and 83%, respectively).
Conclusion: The HepLink intervention is cost-effective compared to the standard-of-care pathway,
especially as treatment costs reduce.
Disclosure of Interest: none

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