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Assessing the cost-effectiveness of treating chronic hepatitis C virus in people who inject drugs in Australia

Authors


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: adam.visconti@ucsf.edu

Abstract

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.

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