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Cost-Effectiveness of Hepatitis C Treatment for People Who Inject Drugs and the Impact of the Type of Epidemic; Extrapolating from Amsterdam, the Netherlands

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  • Daniëla K van Santen
  • Anneke S de Vos
  • Amy Matser
  • Sophie B Willemse
  • Karen Lindenburg
  • Mirjam E E Kretzschmar
  • Maria Prins
  • G Ardine de Wit

Abstract

Background: People who inject drugs (PWID) are disproportionally affected by the 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 pegylated-interferon and ribavirin (PegIFN/RBV). We aimed to assess the cost-effectiveness of four HCV treatment strategies among PWID and treatment scale-up. Methods: An individual-based model was used describing HIV and HCV transmission and disease progression among PWID. We considered two epidemiological situations. A declining epidemic, based on the situation in Amsterdam, the Netherlands, and a stable HCV epidemic, as observed in other settings. Data on HCV incidence, prevalence, treatment setting and uptake were derived from observed data among PWID in Amsterdam. We assessed the incremental cost-effectiveness ratio (ICER, costs in €/quality-adjusted life year (QALY)) of four treatment strategies: 1) PegIFN/RBV; 2) sofosbuvir/RBV for genotype 2–3 and dual DAA for genotype 1–4; 3) Dual DAA for all genotypes; 4) Dual DAA with 3x treatment uptake. Results: In both types of epidemic, dual DAA therapy was most cost-effective strategy. In the declining epidemic, dual DAA yielded an ICER of 344 €/QALY while in the stable epidemic dual DAA led to cost-savings. Scaling-up treatment was also highly cost-effective. Our results were robust over a range of sensitivity analyses. Conclusion: HCV treatment with DAA-containing regimens is a highly cost-effective intervention among PWID. Based on the economic and population benefits of scaling-up treatment, stronger efforts are needed to achieve higher uptake rates among PWID.

Suggested Citation

  • Daniëla K van Santen & Anneke S de Vos & Amy Matser & Sophie B Willemse & Karen Lindenburg & Mirjam E E Kretzschmar & Maria Prins & G Ardine de Wit, 2016. "Cost-Effectiveness of Hepatitis C Treatment for People Who Inject Drugs and the Impact of the Type of Epidemic; Extrapolating from Amsterdam, the Netherlands," PLOS ONE, Public Library of Science, vol. 11(10), pages 1-18, October.
  • Handle: RePEc:plo:pone00:0163488
    DOI: 10.1371/journal.pone.0163488
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    Cited by:

    1. Stephanie Popping & Sebastiaan J Hullegie & Anne Boerekamps & Bart J A Rijnders & Robert J de Knegt & Jürgen K Rockstroh & Annelies Verbon & Charles A B Boucher & Brooke E Nichols & David A M C van de, 2019. "Early treatment of acute hepatitis C infection is cost-effective in HIV-infected men-who-have-sex-with-men," PLOS ONE, Public Library of Science, vol. 14(1), pages 1-15, January.
    2. Ru Han & Clément François & Mondher Toumi, 2021. "Systematic Review of Health State Utility Values Used in European Pharmacoeconomic Evaluations for Chronic Hepatitis C: Impact on Cost-Effectiveness Results," Applied Health Economics and Health Policy, Springer, vol. 19(1), pages 29-44, January.
    3. Anita W M Suijkerbuijk & Albert Jan van Hoek & Jelle Koopsen & Robert A de Man & Marie-Josee J Mangen & Hester E de Melker & Johan J Polder & G Ardine de Wit & Irene K Veldhuijzen, 2018. "Cost-effectiveness of screening for chronic hepatitis B and C among migrant populations in a low endemic country," PLOS ONE, Public Library of Science, vol. 13(11), pages 1-16, November.
    4. Yin Liu & Hui Zhang & Lei Zhang & Xia Zou & Li Ling, 2020. "Economic Evaluation of Hepatitis C Treatment Extension to Acute Infection and Early-Stage Fibrosis Among Patients Who Inject Drugs in Developing Countries: A Case of China," IJERPH, MDPI, vol. 17(3), pages 1-13, January.
    5. Léa Duchesne & Gilles Hejblum & Ndèye Coumba Toure Kane & Richard Njouom & Toni Thomas-d'Aquin & Raoul Moh & Babacar Sylla & Nicolas Rouveau & Alain Attia & Karine Lacombe, 2020. "Model-based cost-effectiveness estimates of testing strategies for diagnosing hepatitis C virus infection in people who use injecting drugs in Senegal," Post-Print hal-02543434, HAL.

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