Cost and Cost-Effectiveness of Hepatitis C Virus Self-Testing in Four Settings

Author: Josephine Walker Elena Ivanova Muhammad S Jamil Jason J Ong Philippa Easterbrook E Fajardo Cheryl C Johnson Luhmann Niklas Fern Terris-Prestholt Peter Vickerman Sonjelle Shilton Fern

Theme: Social Science & Policy Research Year: 2022

Only 20% of 58 million people with chronic hepatitis C virus (HCV) have been diagnosed. HCV selftesting (HCVST) could reach those who have never been tested and increase access and uptake of
HCV testing. We compared cost/HCV diagnosis or cure for HCVST versus facility-based HCV testing.
We used a decision analysis model (time horizon one year) to examine drivers of cost/viremic
diagnosis or cure of HCVST in China (men who have sex with men), Georgia (men 40-49 years), Viet
Nam (people who inject drugs, PWID), Kenya (PWID). HCV antibody (HCVAb) prevalence ranged from
1%-60%. Parameters were informed by HCV testing and treatment programs, HIV self-testing
programs, and expert opinion. We assume reactive HCVST is followed by facility-based rapid
diagnostic test (fRDT) and then nucleic acid testing (NAT). We assumed HCVST costs of $5.63/unit
($0.87-$21.43 for fRDT), 62% increase in testing, 65% linkage to care, and 10% replacement of fRDT
with HCVST, with variation in sensitivity analysis. Outcomes are incremental cost/patient diagnosed
or cured (2019 USD$).
Cost/HCV diagnosis without HCVST ranged from $35 (Viet Nam) to $361 (Kenya). Incremental
cost/person diagnosed was $104 in Viet Nam, $163 in Georgia, $587 in Kenya, and $2,647 in China.
Differences were driven by HCVAb prevalence. In sensitivity analyses, reducing the cost of HCVST,
increasing uptake of HCVST and linkage rate to facility-based care and NAT testing, or proceeding
directly to NAT testing following a positive HCVST, reduced the overall cost per person diagnosed.
The incremental cost/cure was lowest in Georgia ($1,418), with similar outcomes in Viet Nam
($2,033), and Kenya ($2,566), and the highest cost in China ($4,956), driven by differences in DAA
treatment costs.
HCVST increased the number of people tested, diagnosed, and cured, at higher cost. Introducing
HCVST is more cost-effective in populations with high prevalence.
Disclosure of Interest Statement:
EI and SJ are current employees of FIND, EF is a former employee of FIND. JGW and PV have received
unrestricted research funding from Gilead Sciences unrelated to this research. All authors declare no
other conflicts of interest. The findings and conclusions in this report are those of the authors and do
not necessarily represent the official position of the World Health Organization.

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