Elizabeth R. Stevens
Scaling up access to direct-acting antivirals, or DAAs, is the most cost-effective intervention for reducing hepatitis C virus among people who inject drugs when only health sector costs are considered, according to findings from a computer simulation study.
However, when criminal justice system-related costs are included, DAA coverage combined with medication-assisted treatment with syringe access programs, or MAT+, is the most cost-effective strategy, researchers reported.
“Without an aggressive approach that combats both the HCV itself and the injection drug use behaviors associated with its spread, we are unlikely to achieve our HCV reduction goals within the injection drug user population,” Elizabeth R. Stevens, PhD, MPH, scientific director in the department of population health at the New York University School of Medicine, told Infectious Disease News.
“While tackling HCV with DAAs alone is cost-effective, as the high medication cost is offset by its ability to reduce long-term medical costs, providing DAA along with medication assisted therapy (MAT) and sterile needle and syringe programs (NSPs) may be cost-saving for society as it both reduces long-term medical costs as well as the criminal justice system-related costs associated with IDU.”
Stevens and colleagues performed an allocative efficiency study using a mathematical model to simulate the public health and economic impact of alternative combination intervention scenarios.
They assessed cost-efficiency from a health-sector perspective, excluding costs related to the criminal justice system. They reported that 20% DAA coverage conferred an incremental cost-effectiveness ratio (ICER) of $27,251/quality-adjusted life years (QALY). A combination of 20% DAA coverage with 20% MAT+ coverage had an ICER of $165,985/QALY. Additionally, combining 20% DAA coverage with 40% and 80% MAT+ coverage resulted in ICERs of $325,860/QALY and $399,189/QALY, respectively.
“The findings emphasize the importance of making DAAs and MAT/syringe programs more accessible to injection drug users. Currently in the [United States], however, few HCV-positive injection drug users receive DAA treatment and nearly half of states block access to DAAs for active drug users,” Stevens said. “Similarly, the U.S. in general has been unsuccessful in providing access to NSPs, and MAT for those currently eligible for treatment. Without treating HCV with DAAs in active drug users and increasing access to MAT and NSPs, we may be unable to adequately reduce HCV in the IDU population.”
Stevens and colleagues noted that 20% DAA with 80% MAT+ was less cost-saving compared with 80% MAT+ and no DAA, but offered “favorable value” compared with 80% MAT+ alone ($23,932/QALY).
“Further research is needed to determine how to best implement the DAA and MAT/NSP interventions in ways that both maximizes access to and participation in these programs,” Stevens said. – by Marley Ghizzone
Disclosures: The authors report no relevant financial disclosures.