title: Cost-effectiveness of hepatitis C virus antiviral treatment for injection drug user populations.
abstract: Injecting drug use is the main risk of hepatitis C virus (HCV) transmission in most developed countries. HCV antiviral treatment (peginterferon-α + ribavirin) has been shown to be cost-effective for patients with no reinfection risk. We examined the cost-effectiveness of providing antiviral treatment for injecting drug users (IDUs) as compared with treating ex/non-IDUs or no treatment. A dynamic model of HCV transmission and disease progression was developed, incorporating: a fixed number of antiviral treatments allocated at the mild HCV stage over 10 years, no retreatment after treatment failure, potential reinfection, and three baseline IDU HCV chronic prevalence scenarios (20%, 40%, and 60%). We performed a probabilistic cost-utility analysis estimating long-term costs and outcomes measured in quality adjusted life years (QALYs) and calculating the incremental cost-effectiveness ratio (ICER) comparing treating IDUs, ex/non-IDUs, or no treatment. Antiviral treatment for IDUs is the most cost-effective option in the 20% and 40% baseline chronic prevalence settings, with ICERs compared with no treatment of £ 521 and £ 2,539 per QALY saved, respectively. Treatment of ex/non-IDUs is dominated in these scenarios. At 60% baseline prevalence, treating ex/non-IDUs is slightly more likely to be the more cost-effective option (with an ICER compared with no treatment of £ 6,803), and treating IDUs dominated due to high reinfection. A sensitivity analysis indicates these rankings hold even when IDU sustained viral response rates as compared with ex/non-IDUs are halved.
  
  
  CONCLUSIONS
  Despite the possibility of reinfection, the model suggests providing antiviral treatment to IDUs is the most cost-effective policy option in chronic prevalence scenarios less than 60%. Further research on how HCV treatment for injectors can be scaled up and its impact on prevalence is warranted.
authors: Department of Social Medicine, University of Bristol, Bristol, UK. Natasha.Martin@bristol.ac.uk
authors: Natasha K
authors: NK
authors: Martin
authors: Peter
authors: P
authors: Vickerman
authors: Alec
authors: A
authors: Miners
authors: Graham R
authors: GR
authors: Foster
authors: Sharon J
authors: SJ
authors: Hutchinson
authors: David J
authors: DJ
authors: Goldberg
authors: Matthew
authors: M
authors: Hickman
mesh_terms: D000998:Antiviral Agents / Q000191:economics* / Q000627:therapeutic use*; D003362:Cost-Benefit Analysis / Q000706:statistics & numerical data; D016527:Drug Costs / Q000706:statistics & numerical data; D019698:Hepatitis C, Chronic / Q000188:drug therapy* / Q000191:economics* / Q000453:epidemiology; D006801:Humans; D007275:Injections, Intravenous; D016898:Interferon-alpha / Q000191:economics / Q000627:therapeutic use; D009339:Needles; D011092:Polyethylene Glycols / Q000191:economics / Q000627:therapeutic use; D015995:Prevalence; D012254:Ribavirin / Q000191:economics / Q000627:therapeutic use; D012307:Risk Factors; D055502:Secondary Prevention; D019966:Substance-Related Disorders / Q000191:economics* / Q000453:epidemiology; D013594:Syringes; D006113:United Kingdom / Q000453:epidemiology
chemical_list: D000998:Antiviral Agents; D016898:Interferon-alpha; D011092:Polyethylene Glycols; D012254:Ribavirin