title: The cost impact of outreach testing and treatment for hepatitis C in an urban Drug Treatment Unit.
abstract: In developed countries persons who inject drugs (PWID) represents a significant risk for chronic hepatitis C virus (HCV). It is reported that up to half of persons with chronic HCV remain undiagnosed and reliance on attendance to specialist clinics remain a barrier to treatment. This study assesses the feasibility and cost-effectiveness of outreach screening and treatment within a Drug Treatment Unit (DTU).
  
  
  
  All persons attending a London DTU were offered HCV testing, and where appropriate follow-up and treatment by a specialist nurse at the DTU. Three years of data informed a cost-effective-analysis using a validated Markov model. A hypothetical scenario in which only direct acting antiviral (DAA) treatments were used was also assessed.
  
  
  
  Of 321 persons eligible, 216 were screened, 89 were HCV positive and 66 had confirmatory evidence of viraemia. All were infected with either HCV genotype 1 or 3. Treatment was initiated in 29 persons, 22 with interferon based and 7 DAA only regimens. Following initial treatment 21 (72%) achieved SVR12. It is estimated that this programme represents an average per-patient cost-saving of £2498 and a quality-adjusted life year (QALY) gain of 4.10 over a lifetime. In a hypothetical scenario of all oral DAA treatment, an incremental cost per QALY of £1029 was estimated.
  
  
  
  This study demonstrates feasibility and cost effectiveness of outreach testing and treatment of hepatitis C within comparable DTU settings. Additional costs of newer DAA therapies would not be prohibitive when considering willingness-to-pay thresholds commonly used by policy makers.
authors: Department of Hepatology, Imperial College, London, UK.|Liver and Antiviral Unit, Imperial College Healthcare NHS Trust, London, UK.
authors: Nowlan
authors: N
authors: Selvapatt
authors: Health Economics and Outcomes Research Ltd, Cardiff, UK.
authors: Thomas
authors: T
authors: Ward
authors: Liver and Antiviral Unit, Imperial College Healthcare NHS Trust, London, UK.
authors: Lorna
authors: L
authors: Harrison
authors: Addictions Directorate, Central and North West London NHS Foundation Trust, London, UK.
authors: Jody
authors: J
authors: Lombardini
authors: Department of Hepatology, Imperial College, London, UK.
authors: Mark
authors: M
authors: Thursz
authors: Health Economics and Outcomes Research Ltd, Cardiff, UK.|School of Human and Health Sciences, Swansea University, Swansea, UK.
authors: Phil
authors: P
authors: McEwan
authors: Liver and Antiviral Unit, Imperial College Healthcare NHS Trust, London, UK.
authors: Ashley
authors: A
authors: Brown
mesh_terms: D000328:Adult; D000998:Antiviral Agents / Q000191:economics* / Q000627:therapeutic use; D003362:Cost-Benefit Analysis; D005260:Female; D017048:Health Care Costs / Q000706:statistics & numerical data*; D016174:Hepacivirus; D019698:Hepatitis C, Chronic / Q000188:drug therapy / Q000191:economics*; D006801:Humans; D008131:London; D008297:Male; D008403:Mass Screening / Q000191:economics*; D008875:Middle Aged; D019057:Quality-Adjusted Life Years; D019966:Substance-Related Disorders / Q000150:complications*; D000072230:Sustained Virologic Response; D013808:Therapeutic Community; D055815:Young Adult
chemical_list: D000998:Antiviral Agents
keywords: cost-effectiveness; hepatitis C; outreach; persons who inject drugs; screening