Evaluating the Cost-Effectiveness of Integrated Treatment for Hepatitis C Virus Among People who Inject Drugs in Norway

Author: Aaron Lim Christer Frode Aas Ege Su Çaglar Jørn-Henrik Vold Lars Thore Fadnes Kjell Arne Johansson Peter Vickerman

Theme: Epidemiology & Public Health Research Year: 2022

Background: Implementing HCV treatment through efficient delivery platforms for people who inject drugs
(PWID) is required for this hard-to-reach population. The INTRO-HCV randomised control trial conducted in
Norway over 2017-2019 found that HCV treatment, using direct-acting antivirals (DAAs), integrated into
multidisciplinary opioid agonist therapy (OAT) clinics improved treatment outcomes, but the longer-term
health economic benefits were not assessed. This study analyses the cost-effectiveness of integrated
treatment compared to the standard referral pathway of care.
Methods: A health state-transition Markov model of HCV disease progression and treatment was
developed based on the INTRO-HCV trial. Treatment unit costs and health-related quality of life outcome
data were derived from the trial and used to parameterise the model. The incremental cost-effectiveness
ratio (ICER) was calculated as cost per quality-adjusted life year (QALY) gained from the health provider’s
perspective over a lifetime horizon and compared against a conventional (NOK 500,000) willingness-to-pay
threshold. Probabilistic and univariate sensitivity analyses were undertaken, focussing on the effect of DAA
price reductions from list prices.
Results: Compared to standard treatment, integrated treatment resulted in an ICER of NOK 213,500/QALY
gained, with 90.8% probability of being cost-effective against the conventional willingness-to-pay
threshold. Sensitivity analyses suggest that DAA medication costs strongly affected the ICER, with 30%
lower DAA price resulting in integrated treatment having an ICER of NOK 107,100/QALY gained and 98.2%
probability of being cost-effective. A 60% lower DAA price led to a negative ICER of NOK -24,400/QALY
gained, with 99.9% probability of being cost-effective and 67.7% probability of being cost-saving. A 90%
lower DAA price had a negative ICER of NOK -155,500/QALY gained and 100% probability of being costsaving.
Conclusion: Integrating HCV treatment for PWID in community settings is likely to be highly cost-effective
compared to standard referral pathways and may become cost-saving even with moderate reductions in
DAA price.
Disclosure of Interest Statement: Nothing to disclose.

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