title: Cost-effectiveness of treating chronic hepatitis C virus with direct-acting antivirals in people who inject drugs in Australia.
abstract: OBJECTIVE
  Reducing the burden of hepatitis C virus (HCV) related liver disease will require treating people who inject drugs (PWID), the group at most risk of infection and transmission. We determine the cost-effectiveness of treating PWID with interferon-free direct-acting antiviral therapy in Australia.
  
  
  METHODS
  Using a deterministic model of HCV treatment and liver disease progression, including a fixed rate of re-infection, the expected healthcare costs and quality-adjusted life years (QALYs) of a cohort of newly HCV-infected PWID were calculated for: no treatment; treatment after initial infection ("early-treatment"); and treatment prior to developing compensated cirrhosis ("late-treatment"). Incremental cost-effectiveness ratios (ICERs) were used to compare scenarios.
  
  
  RESULTS
  Late-treatment was cost-effective compared to no treatment, with a discounted average gain of 2.98 (95%confidence interval 2.88-5.22) QALYs per person for an additional cost of $15,132 ($11,246-18,922), giving an ICER of $5078 ($2847-5295) per QALY gained. Compared to late-treatment, early-treatment gained a further discounted average of 2.27 (0.58-4.80) QALYs per person for $38,794 ($34,789-41,367), giving an ICER of $17,090 ($2847-63,282), which was cost-effective in approximately 90% of Monte-Carlo uncertainty simulations. For every 100 newly HCV-infected PWID, there were an estimated 40 (39-56) eventual liver-related deaths without treatment, compared to 7 (6-11) and 8 (7-13) with early-treatment and late-treatment available respectively.
  
  
  CONCLUSIONS
  Treating HCV-infected PWID with new therapies is cost-effective and could prevent a significant number of liver-related deaths. Although late-treatment was the most cost-effective option, the cost per QALY gained for early-treatment compared to late-treatment is likely to be below unofficial Australian willingness to pay thresholds.
authors.affiliation: Centre for Population Health, Burnet Institute, Melbourne, Victoria, Australia.|Department of Epidemiology and Preventative Medicine, Monash University, Clayton, Victoria, Australia.
authors.forename: Nick
authors.initials: N
authors.lastname: Scott
authors.affiliation: Department of Infectious Diseases, Alfred Hospital, Melbourne, Victoria, Australia.|Department of Gastroenterology, St Vincent's Hospital Melbourne, Fitzroy, Victoria, Australia.
authors.forename: David M
authors.initials: DM
authors.lastname: Iser
authors.affiliation: Department of Gastroenterology, St Vincent's Hospital Melbourne, Fitzroy, Victoria, Australia.|Department of Medicine, The University of Melbourne, Parkville, Victoria, Australia.
authors.forename: Alexander J
authors.initials: AJ
authors.lastname: Thompson
authors.affiliation: Centre for Population Health, Burnet Institute, Melbourne, Victoria, Australia.|Department of Medicine, The University of Melbourne, Parkville, Victoria, Australia.|Victorian Infectious Diseases Service at the Doherty Institute, Melbourne Health, Melbourne, Victoria, Australia.
authors.forename: Joseph S
authors.initials: JS
authors.lastname: Doyle
authors.affiliation: Centre for Population Health, Burnet Institute, Melbourne, Victoria, Australia.|Department of Epidemiology and Preventative Medicine, Monash University, Clayton, Victoria, Australia.|Department of Infectious Diseases, Alfred Hospital, Melbourne, Victoria, Australia.
authors.forename: Margaret E
authors.initials: ME
authors.lastname: Hellard
mesh_terms: D000293:Adolescent; D000328:Adult; D000998:Antiviral Agents / Q000008:administration & dosage* / Q000191:economics*; D001315:Australia; D002648:Child; D015331:Cohort Studies; D003362:Cost-Benefit Analysis; D018450:Disease Progression; D017048:Health Care Costs; D019698:Hepatitis C, Chronic / Q000188:drug therapy* / Q000191:economics* / Q000401:mortality / Q000635:transmission; D006801:Humans; D008954:Models, Biological; D019057:Quality-Adjusted Life Years; D012008:Recurrence; D015819:Substance Abuse, Intravenous; D055815:Young Adult
chemical_list: D000998:Antiviral Agents
keywords: cost-effectiveness; direct-acting antivirals; hepatitis C virus; people who inject drugs