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Cost‐effectiveness of the HepCATT intervention in specialist drug clinics to improve case‐finding and engagement with HCV treatment for people who inject drugs in England.

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Title: Cost‐effectiveness of the HepCATT intervention in specialist drug clinics to improve case‐finding and engagement with HCV treatment for people who inject drugs in England.
Authors: Ward, Zoe (AUTHOR), Reynolds, Rosie (AUTHOR), Campbell, Linda (AUTHOR), Martin, Natasha K. (AUTHOR), Harrison, Graham (AUTHOR), Irving, William (AUTHOR), Hickman, Matthew (AUTHOR), Vickerman, Peter (AUTHOR)
Source: Addiction. Aug2020, Vol. 115 Issue 8, p1509-1521. 13p. 5 Charts, 3 Graphs.
Subjects: Hepatitis C prevention, Cost control, Medical care costs, Medical referrals, Medical screening, Risk assessment, Statistics, Substance abuse treatment, Treatment programs, Drug abusers, Quality-adjusted life years
Geographic Terms: England
Abstract: Background and Aims: People who inject drugs (PWID) are at high risk of hepatitis C virus (HCV) infection; however, ~50% are undiagnosed in England and linkage‐to‐care is poor. This study investigated the cost‐effectiveness of an intervention (HepCATT) to improve case‐finding and referral to HCV treatment compared with standard‐of‐care pathways in drug treatment centres in England. Design HCV transmission and disease progression model with cost‐effectiveness analysis using a health‐care perspective. Primary outcome and cost data from the HepCATT study parameterized the intervention, suggesting that HepCATT increased HCV testing in drug treatment centres 2.5‐fold and engagement onto the HCV treatment pathway 10‐fold. A model was used to estimate the decrease in HCV infections and HCV‐related deaths from 2016, with costs and health benefits (quality‐adjusted life‐years or QALYs) tracked over 50 years. Univariable and probabilistic sensitivity analyses (PSA) were undertaken. Setting: England‐specific epidemic with 40% prevalence of chronic HCV among PWID. Participants: PWID attending drug treatment centres. Intervention: Nurse facilitator in drug treatment centres to improve the HCV care pathway from HCV case‐finding to referral and linkage to specialist care. Comparator was the standard‐of‐care HCV care pathway. Measurements Incremental cost‐effectiveness ratio (ICER) in terms of cost per QALY gained through improved case‐finding. Findings Over 50 years per 1000 PWID, the HepCATT intervention could prevent 75 (95% central interval 37–129) deaths and 1330 (827–2040) or 51% (30–67%) of all new infections. The mean ICER was £7986 per QALY gained, with all PSA simulations being cost‐effective at a £20 000 per QALY willingness‐to‐pay threshold. Univariable sensitivity analyses suggest the intervention would become cost‐saving if the cost of HCV treatment reduces to £3900. If scaled up to all PWID in England, the intervention would cost £8.8 million and decrease incidence by 56% (33–70%) by 2030. Conclusions: Increasing hepatitis C virus infection case‐finding and treatment referral in drug treatment centres could be a highly cost‐effective strategy for decreasing hepatitis C virus incidence among people who inject drugs. [ABSTRACT FROM AUTHOR]
Copyright of Addiction is the property of Wiley-Blackwell and its content may not be copied or emailed to multiple sites without the copyright holder's express written permission. Additionally, content may not be used with any artificial intelligence tools or machine learning technologies. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)
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  Data: Cost‐effectiveness of the HepCATT intervention in specialist drug clinics to improve case‐finding and engagement with HCV treatment for people who inject drugs in England.
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  Data: <searchLink fieldCode="AR" term="%22Ward%2C+Zoe%22">Ward, Zoe</searchLink> (AUTHOR)<br /><searchLink fieldCode="AR" term="%22Reynolds%2C+Rosie%22">Reynolds, Rosie</searchLink> (AUTHOR)<br /><searchLink fieldCode="AR" term="%22Campbell%2C+Linda%22">Campbell, Linda</searchLink> (AUTHOR)<br /><searchLink fieldCode="AR" term="%22Martin%2C+Natasha+K%2E%22">Martin, Natasha K.</searchLink> (AUTHOR)<br /><searchLink fieldCode="AR" term="%22Harrison%2C+Graham%22">Harrison, Graham</searchLink> (AUTHOR)<br /><searchLink fieldCode="AR" term="%22Irving%2C+William%22">Irving, William</searchLink> (AUTHOR)<br /><searchLink fieldCode="AR" term="%22Hickman%2C+Matthew%22">Hickman, Matthew</searchLink> (AUTHOR)<br /><searchLink fieldCode="AR" term="%22Vickerman%2C+Peter%22">Vickerman, Peter</searchLink> (AUTHOR)
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  Data: <searchLink fieldCode="JN" term="%22Addiction%22">Addiction</searchLink>. Aug2020, Vol. 115 Issue 8, p1509-1521. 13p. 5 Charts, 3 Graphs.
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  Data: Background and Aims: People who inject drugs (PWID) are at high risk of hepatitis C virus (HCV) infection; however, ~50% are undiagnosed in England and linkage‐to‐care is poor. This study investigated the cost‐effectiveness of an intervention (HepCATT) to improve case‐finding and referral to HCV treatment compared with standard‐of‐care pathways in drug treatment centres in England. Design HCV transmission and disease progression model with cost‐effectiveness analysis using a health‐care perspective. Primary outcome and cost data from the HepCATT study parameterized the intervention, suggesting that HepCATT increased HCV testing in drug treatment centres 2.5‐fold and engagement onto the HCV treatment pathway 10‐fold. A model was used to estimate the decrease in HCV infections and HCV‐related deaths from 2016, with costs and health benefits (quality‐adjusted life‐years or QALYs) tracked over 50 years. Univariable and probabilistic sensitivity analyses (PSA) were undertaken. Setting: England‐specific epidemic with 40% prevalence of chronic HCV among PWID. Participants: PWID attending drug treatment centres. Intervention: Nurse facilitator in drug treatment centres to improve the HCV care pathway from HCV case‐finding to referral and linkage to specialist care. Comparator was the standard‐of‐care HCV care pathway. Measurements Incremental cost‐effectiveness ratio (ICER) in terms of cost per QALY gained through improved case‐finding. Findings Over 50 years per 1000 PWID, the HepCATT intervention could prevent 75 (95% central interval 37–129) deaths and 1330 (827–2040) or 51% (30–67%) of all new infections. The mean ICER was £7986 per QALY gained, with all PSA simulations being cost‐effective at a £20 000 per QALY willingness‐to‐pay threshold. Univariable sensitivity analyses suggest the intervention would become cost‐saving if the cost of HCV treatment reduces to £3900. If scaled up to all PWID in England, the intervention would cost £8.8 million and decrease incidence by 56% (33–70%) by 2030. Conclusions: Increasing hepatitis C virus infection case‐finding and treatment referral in drug treatment centres could be a highly cost‐effective strategy for decreasing hepatitis C virus incidence among people who inject drugs. [ABSTRACT FROM AUTHOR]
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  Data: <i>Copyright of Addiction is the property of Wiley-Blackwell and its content may not be copied or emailed to multiple sites without the copyright holder's express written permission. Additionally, content may not be used with any artificial intelligence tools or machine learning technologies. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract.</i> (Copyright applies to all Abstracts.)
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        Value: 10.1111/add.14978
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      – Code: eng
        Text: English
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      – SubjectFull: Hepatitis C prevention
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      – SubjectFull: Medical care costs
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