Theme: Clinical Research Year: 2015
Background: People who inject drugs (PWID) are the main group affected with Hepatitis C virus (HCV) infection. The efficacy of HCV treatment has significantly improved in recent years with the introduction of direct-acting antivirals (DAAs). However, DAAs are more costly than the traditional peginterferon and ribavirin (PegIFN/RBV) therapy. Hence, we aimed to assess the cost-effectiveness of different HCV treatment strategies among PWID.
Methods: An individual-based model was used describing HIV and HCV transmission and disease progression among PWID. We considered two Epidemiology & Public Health Researchdemiological situations: a declining and a stable HCV Epidemiology & Public Health Researchdemic. Parameters describing the declining HCV Epidemiology & Public Health Researchdemic, treatment setting and uptake were derived from data among PWID from Amsterdam. The model was then adapted to reflect a stable HCV Epidemiology & Public Health Researchdemic among PWID. We assessed the incremental cost-effectiveness ratio (ICER, costs in euros/quality adjusted life years (QALYs)) of six strategies for both Epidemiology & Public Health Researchdemiological situations: 1) No therapy; 2) PegIFN/RBV; 3) DAA/RBV; 4) DAA/RBV for genotype 2-3 and DAA/RBV/PegIFN for genotype 1-4; 5) DAA/RBV for genotype 2-3 and two DAAs for genotype 1-4 and 6) Two DAAs for all genotypes.
Results: In the declining Epidemiology & Public Health Researchdemic, treatment with two DAAs for all genotypes is very cost-effective and dominates all other strategies. In the stable Epidemiology & Public Health Researchdemic, DAA/RBV for genotype 2-3 and two DAAs for genotype 1-4 is very cost-effective and the dominant strategy. Although the ICERs of the aforementioned dominant strategies are the lowest, all treatment strategies fall below the willingness to pay threshold and are cost-effective when compared to a scenario with no therapy.
Conclusion: HCV treatment with DAA-containing regimes is a very cost-effective intervention among PWID, irrespective of the type of HCV Epidemiology & Public Health Researchdemic. Given the increased gain in QALYs by HCV treatment and the low cost per QALY gained, stronger efforts are needed to implement and scale-up HCV treatment among PWID.Download abstract Download presentation