Assessing the cost-effectiveness of treating chronic hepatitis C virus in people who inject drugs in Australia
Corresponding Author
Adam J Visconti
School of Medicine, University of California, San Francisco, San Francisco, California, USA
The Centre of Excellence in Intervention and Prevention Science, Carlton South
Correspondence
Mr Adam J Visconti, School of Medicine, University of California, MS-3, 513 Parnassus Avenue, Room S-245, San Francisco, CA 94143, USA. Email: [email protected]
Search for more papers by this authorJoseph S Doyle
Infectious Diseases Unit, The Alfred
Department of Epidemiology and Preventative Medicine, Monash University, Melbourne, Victoria, Australia
Search for more papers by this authorAlan M Shiell
The Centre of Excellence in Intervention and Prevention Science, Carlton South
Search for more papers by this authorMargaret E Hellard
Centre for Population Health, Burnet Institute
Infectious Diseases Unit, The Alfred
Department of Epidemiology and Preventative Medicine, Monash University, Melbourne, Victoria, Australia
Search for more papers by this authorCorresponding Author
Adam J Visconti
School of Medicine, University of California, San Francisco, San Francisco, California, USA
The Centre of Excellence in Intervention and Prevention Science, Carlton South
Correspondence
Mr Adam J Visconti, School of Medicine, University of California, MS-3, 513 Parnassus Avenue, Room S-245, San Francisco, CA 94143, USA. Email: [email protected]
Search for more papers by this authorJoseph S Doyle
Infectious Diseases Unit, The Alfred
Department of Epidemiology and Preventative Medicine, Monash University, Melbourne, Victoria, Australia
Search for more papers by this authorAlan M Shiell
The Centre of Excellence in Intervention and Prevention Science, Carlton South
Search for more papers by this authorMargaret E Hellard
Centre for Population Health, Burnet Institute
Infectious Diseases Unit, The Alfred
Department of Epidemiology and Preventative Medicine, Monash University, Melbourne, Victoria, Australia
Search for more papers by this authorAbstract
Background and Aim
To assess the cost-effectiveness of hepatitis C virus treatment with pegylated interferon alfa-2a and ribavirin in current and former people who inject drugs (PWID).
Methods
A decision analytic model simulated the lifetime costs and outcomes of four treatment options: early treatment with mild fibrosis, standard treatment with moderate fibrosis, late treatment with compensated cirrhosis, and no treatment. Treatment modalities were simulated across current, former, and never-injector cohorts of 1000 hypothetical patients with chronic hepatitis C virus. The main outcome measures were incremental costs ($AUD) per quality-adjusted life years (QALYs) gained, and incremental cost-effectiveness ratios (ICERs) were calculated for each cohort.
Results
Treatment of current PWID during mild fibrosis resulted in a discounted average gain of 1.60 QALYs (95% confidence interval 0.93–2.26) for an added cost of $12 723 ($11 153–$14 396) compared with no treatment, yielding an ICER of $7941 per QALY gained ($6347–$12 017). Former PWID gained 1.80 QALYs (1.29–2.33) for $10 441 ($8843–$12 074) for early treatment compared with no treatment, resulting in an ICER of $5808 per QALY gained ($5189–$6849). Never-injectors gained 2.33 QALYs (1.87–2.80) for $9290 ($7642–$10 912) compared with no treatment—an ICER of $3985 per QALY gained ($3896–$4080). Early treatment was more cost-effective than late treatment in all cohorts.
Conclusions
Despite comorbidities, increased mortality, and reduced adherence, treatment of both current and former PWID is cost-effective. Our estimates fall below the unofficial Australian cost-effectiveness threshold of $AUD 50 000 per QALY for public subsidies. Scaling up treatment for PWID can be justified on purely economic grounds.
Supporting Information
| Filename | Description |
|---|---|
| jgh12041-sup-0001-si.pdf1.9 MB |
Figures S1 Decision analytic model—non-injector. |
| jgh12041-sup-0002-si.pdf2.7 MB |
Figure S2 Decision analytic model—active PWID. |
| jgh12041-sup-0003-si.pdf5.3 MB |
Figure S3 Decision analytic model—former PWID. |
| jgh12041-sup-0004-si.jpeg386.2 KB |
Figure S4 Cost-effectiveness acceptability curve—non-injector. |
| jgh12041-sup-0005-si.jpeg386.2 KB |
Figure S5 Cost-effectiveness acceptability curve—active PWID. |
| jgh12041-sup-0006-si.jpeg385.2 KB |
Figure S6 Cost-effectiveness acceptability curve—former PWID. |
| jgh12041-sup-0007-si.xlsx69.5 KB |
Table S1 Disaggregated costs estimates for hepatitis C virus disease states. |
| jgh12041-sup-0008-si.xlsx47 KB |
Table S2 Calculated lifetime costs and outcomes with 0%, 3%, and 5% discount rates. |
| jgh12041-sup-0009-si.xlsx45.2 KB |
Table S3 Projected natural history of disease for hypothetical cohorts. |
| jgh12041-sup-0010-si.xlsx46.3 KB |
Table S4 ICER one-way sensitivity analyses of selected model variables. |
| jgh12041-sup-0011-si.xlsx50.7 KB |
Table S5 Projected costs and outcomes and incremental cost-effectiveness ratios for protease inhibitor treatment for chronic hepatitis C virus infection with genotype 1. |
| jgh12041-sup-0012-si.docx155.4 KB |
Appendix S1 Additional explanations on model structure and assumptions. |
Please note: The publisher is not responsible for the content or functionality of any supporting information supplied by the authors. Any queries (other than missing content) should be directed to the corresponding author for the article.
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