title: Cost-Effectiveness of Hepatitis C Treatment for People Who Inject Drugs and the Impact of the Type of Epidemic; Extrapolating from Amsterdam, the Netherlands.
abstract: BACKGROUND
  People who inject drugs (PWID) are disproportionally affected by the hepatitis C virus (HCV) infection. The efficacy of HCV treatment has significantly improved in recent years with the introduction of direct-acting antivirals (DAAs). However, DAAs are more costly than pegylated-interferon and ribavirin (PegIFN/RBV). We aimed to assess the cost-effectiveness of four HCV treatment strategies among PWID and treatment scale-up.
  
  
  METHODS
  An individual-based model was used describing HIV and HCV transmission and disease progression among PWID. We considered two epidemiological situations. A declining epidemic, based on the situation in Amsterdam, the Netherlands, and a stable HCV epidemic, as observed in other settings. Data on HCV incidence, prevalence, treatment setting and uptake were derived from observed data among PWID in Amsterdam. We assessed the incremental cost-effectiveness ratio (ICER, costs in €/quality-adjusted life year (QALY)) of four treatment strategies: 1) PegIFN/RBV; 2) sofosbuvir/RBV for genotype 2-3 and dual DAA for genotype 1-4; 3) Dual DAA for all genotypes; 4) Dual DAA with 3x treatment uptake.
  
  
  RESULTS
  In both types of epidemic, dual DAA therapy was most cost-effective strategy. In the declining epidemic, dual DAA yielded an ICER of 344 €/QALY while in the stable epidemic dual DAA led to cost-savings. Scaling-up treatment was also highly cost-effective. Our results were robust over a range of sensitivity analyses.
  
  
  CONCLUSIONS
  HCV treatment with DAA-containing regimens is a highly cost-effective intervention among PWID. Based on the economic and population benefits of scaling-up treatment, stronger efforts are needed to achieve higher uptake rates among PWID.
authors.affiliation: Department of Infectious Disease Research and Prevention, Public Health Service of Amsterdam, Amsterdam, the Netherlands.
authors.forename: Daniëla K
authors.initials: DK
authors.lastname: van Santen
authors.affiliation: Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, the Netherlands.
authors.forename: Anneke S
authors.initials: AS
authors.lastname: de Vos
authors.affiliation: Department of Infectious Disease Research and Prevention, Public Health Service of Amsterdam, Amsterdam, the Netherlands.
authors.forename: Amy
authors.initials: A
authors.lastname: Matser
authors.affiliation: Department of Gastroenterology and Hepatology, Academic Medical Center, Amsterdam, the Netherlands.
authors.forename: Sophie B
authors.initials: SB
authors.lastname: Willemse
authors.affiliation: Department of Infectious Disease Research and Prevention, Public Health Service of Amsterdam, Amsterdam, the Netherlands.
authors.forename: Karen
authors.initials: K
authors.lastname: Lindenburg
authors.affiliation: Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, the Netherlands.|National Institute of Public Health and the Environment, Bilthoven, the Netherlands.
authors.forename: Mirjam E E
authors.initials: ME
authors.lastname: Kretzschmar
authors.affiliation: Department of Infectious Disease Research and Prevention, Public Health Service of Amsterdam, Amsterdam, the Netherlands.|Department of Infectious Diseases, Center for Infection and Immunology Amsterdam (CINIMA), Academic Medical Center (AMC), Amsterdam, the Netherlands.
authors.forename: Maria
authors.initials: M
authors.lastname: Prins
authors.affiliation: Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, the Netherlands.|National Institute of Public Health and the Environment, Bilthoven, the Netherlands.
authors.forename: G Ardine
authors.initials: GA
authors.lastname: de Wit
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000998:Antiviral Agents / Q000191:economics* / Q000627:therapeutic use; D003362:Cost-Benefit Analysis; D005260:Female; D006526:Hepatitis C / Q000150:complications / Q000188:drug therapy* / Q000453:epidemiology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009426:Netherlands / Q000453:epidemiology; D015995:Prevalence; D019966:Substance-Related Disorders / Q000150:complications*; D035501:Uncertainty
chemical_list: D000998:Antiviral Agents