title: Cost-effectiveness of rapid hepatitis C virus (HCV) testing and simultaneous rapid HCV and HIV testing in substance abuse treatment programs.
abstract: OBJECTIVE
  To evaluate the cost-effectiveness of rapid hepatitis C virus (HCV) and simultaneous HCV/HIV antibody testing in substance abuse treatment programs.
  
  
  METHODS
  We used a decision analytic model to compare the cost-effectiveness of no HCV testing referral or offer, off-site HCV testing referral, on-site rapid HCV testing offer and on-site rapid HCV and HIV testing offer. Base case inputs included 11% undetected chronic HCV, 0.4% undetected HIV, 35% HCV co-infection among HIV-infected, 53% linked to HCV care after testing antibody-positive and 67% linked to HIV care. Disease outcomes were estimated from established computer simulation models of HCV [Hepatitis C Cost-Effectiveness (HEP-CE)] and HIV [Cost-Effectiveness of Preventing AIDS Complications (CEPAC)].
  
  
  METHODS
  Data on test acceptance and costs were from a national randomized trial of HIV testing strategies conducted at 12 substance abuse treatment programs in the United States.
  
  
  METHODS
  Lifetime costs (2011 US$) and quality-adjusted life years (QALYs) discounted at 3% annually; incremental cost-effectiveness ratios (ICERs).
  
  
  RESULTS
  On-site rapid HCV testing had an ICER of $18,300/QALY compared with no testing, and was more efficient than (dominated) off-site HCV testing referral. On-site rapid HCV and HIV testing had an ICER of $64,500/QALY compared with on-site rapid HCV testing alone. In one- and two-way sensitivity analyses, the ICER of on-site rapid HCV and HIV testing remained <$100,000/QALY, except when undetected HIV prevalence was <0.1% or when we assumed frequent HIV testing elsewhere. The ICER remained <$100,000/QALY in 91% of probabilistic sensitivity analyses.
  
  
  CONCLUSIONS
  On-site rapid hepatitis C virus and HIV testing in substance abuse treatment programs is cost-effective at a <$100,000/quality-adjusted life year threshold.
authors.affiliation: Department of Healthcare Policy and Research, Weill Cornell Medical College, New York, NY, USA.
authors.forename: Bruce R
authors.initials: BR
authors.lastname: Schackman
authors.forename: Jared A
authors.initials: JA
authors.lastname: Leff
authors.forename: Devra M
authors.initials: DM
authors.lastname: Barter
authors.forename: Madeline A
authors.initials: MA
authors.lastname: DiLorenzo
authors.forename: Daniel J
authors.initials: DJ
authors.lastname: Feaster
authors.forename: Lisa R
authors.initials: LR
authors.lastname: Metsch
authors.forename: Kenneth A
authors.initials: KA
authors.lastname: Freedberg
authors.forename: Benjamin P
authors.initials: BP
authors.lastname: Linas
mesh_terms: D000328:Adult; D000066491:Clinical Decision-Making; D015331:Cohort Studies; D003362:Cost-Benefit Analysis; D003661:Decision Support Techniques; D005260:Female; D015658:HIV Infections / Q000175:diagnosis* / Q000191:economics; D019698:Hepatitis C, Chronic / Q000175:diagnosis* / Q000191:economics; D006801:Humans; D008297:Male; D008875:Middle Aged; D019095:Point-of-Care Systems / Q000191:economics*; D019966:Substance-Related Disorders / Q000191:economics / Q000534:rehabilitation*
keywords: Computer simulation model; cost-effectiveness; economic evaluation; hepatitis C testing; rapid HIV testing; substance abuse treatment