title: Assessing the cost-effectiveness of treating chronic hepatitis C virus in people who inject drugs in Australia.
abstract: OBJECTIVE
  To assess the cost-effectiveness of hepatitis C virus treatment with pegylated interferon alfa-2a and ribavirin in current and former people who inject drugs (PWID).
  
  
  METHODS
  A decision analytic model simulated the lifetime costs and outcomes of four treatment options: early treatment with mild fibrosis, standard treatment with moderate fibrosis, late treatment with compensated cirrhosis, and no treatment. Treatment modalities were simulated across current, former, and never-injector cohorts of 1000 hypothetical patients with chronic hepatitis C virus. The main outcome measures were incremental costs ($AUD) per quality-adjusted life years (QALYs) gained, and incremental cost-effectiveness ratios (ICERs) were calculated for each cohort.
  
  
  RESULTS
  Treatment of current PWID during mild fibrosis resulted in a discounted average gain of 1.60 QALYs (95% confidence interval 0.93-2.26) for an added cost of $12,723 ($11,153-$14,396) compared with no treatment, yielding an ICER of $7941 per QALY gained ($6347-$12,017). Former PWID gained 1.80 QALYs (1.29-2.33) for $10,441 ($8843-$12,074) for early treatment compared with no treatment, resulting in an ICER of $5808 per QALY gained ($5189-$6849). Never-injectors gained 2.33 QALYs (1.87-2.80) for $9290 ($7642-$10,912) compared with no treatment-an ICER of $3985 per QALY gained ($3896-$4080). Early treatment was more cost-effective than late treatment in all cohorts.
  
  
  CONCLUSIONS
  Despite comorbidities, increased mortality, and reduced adherence, treatment of both current and former PWID is cost-effective. Our estimates fall below the unofficial Australian cost-effectiveness threshold of $AUD 50,000 per QALY for public subsidies. Scaling up treatment for PWID can be justified on purely economic grounds.
authors.affiliation: School of Medicine, University of California, San Francisco, San Francisco, California 94143, USA. adam.visconti@ucsf.edu
authors.forename: Adam J
authors.initials: AJ
authors.lastname: Visconti
authors.forename: Joseph S
authors.initials: JS
authors.lastname: Doyle
authors.forename: Amanda
authors.initials: A
authors.lastname: Weir
authors.forename: Alan M
authors.initials: AM
authors.lastname: Shiell
authors.forename: Margaret E
authors.initials: ME
authors.lastname: Hellard
mesh_terms: D000328:Adult; D000998:Antiviral Agents / Q000191:economics* / Q000627:therapeutic use; D001315:Australia; D015331:Cohort Studies; D003362:Cost-Benefit Analysis; D004359:Drug Therapy, Combination / Q000191:economics; D061345:Early Medical Intervention; D005260:Female; D019698:Hepatitis C, Chronic / Q000188:drug therapy / Q000191:economics*; D006801:Humans; D016898:Interferon-alpha / Q000191:economics* / Q000627:therapeutic use; D008297:Male; D008390:Markov Chains; D015233:Models, Statistical; D011092:Polyethylene Glycols / Q000191:economics* / Q000627:therapeutic use; D019057:Quality-Adjusted Life Years; D011994:Recombinant Proteins / Q000191:economics / Q000627:therapeutic use; D012254:Ribavirin / Q000191:economics* / Q000627:therapeutic use; D015819:Substance Abuse, Intravenous / Q000191:economics*; D014739:Victoria
chemical_list: D000998:Antiviral Agents; D016898:Interferon-alpha; D011994:Recombinant Proteins; D011092:Polyethylene Glycols; D012254:Ribavirin; C100416:peginterferon alfa-2a