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Cost‐effectiveness of integrated treatment for hepatitis C virus (HCV) among people who inject drugs in Norway: An economic evaluation of the INTRO‐HCV trial.

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Title: Cost‐effectiveness of integrated treatment for hepatitis C virus (HCV) among people who inject drugs in Norway: An economic evaluation of the INTRO‐HCV trial.
Authors: Lim, Aaron Guanliang, Aas, Christer Frode, Çağlar, Ege Su, Vold, Jørn Henrik, Fadnes, Lars Thore, Vickerman, Peter, Johansson, Kjell Arne
Source: Addiction. Dec2023, Vol. 118 Issue 12, p2424-2439. 16p.
Subjects: Evaluation of medical care, Narcotics, Disease progression, Statistics, Intravenous drug abusers, Clinical trials, Hepatitis C, Antiviral agents, Health status indicators, Cost control, Community health services, Randomized controlled trials, Comparative studies, Cost effectiveness, Psychosocial factors, Quality of life, Descriptive statistics, Integrated health care delivery, Statistical sampling, Opioid analgesics, Longitudinal method
Geographic Terms: Norway
Abstract: Background and aims: The INTRO‐HCV randomized controlled trial conducted in Norway over 2017–2019 found that integrated treatment, compared with standard‐of‐care hospital treatment, for hepatitis C virus (HCV) with direct‐acting antivirals (DAAs) improved treatment outcomes among people who inject drugs (PWID). We evaluated cost‐effectiveness of the INTRO‐HCV intervention. Design: A Markov health state transition model of HCV disease progression and treatment with cost‐effectiveness analysis from the health‐provider perspective. Primary cost, utility, and health outcome data were derived from the trial. Costs and health benefits (quality‐adjusted life‐years, QALYs) were tracked over 50 years. Probabilistic and univariate sensitivity analyses investigated DAA price reductions and variations in HCV treatment and disease care cost assumptions, using costs from different countries (Norway, United Kingdom, United States, France, Australia). Setting and participants: PWID attending community‐based drug treatment centers for people with opioid dependence in Norway. Measurements Incremental cost‐effectiveness ratio (ICER) in terms of cost per QALY gained, compared against a conventional (€70 000/QALY) willingness‐to‐pay threshold for Norway and lower (€20 000/QALY) threshold common among high‐income countries. Findings Integrated treatment resulted in an ICER of €13 300/QALY gained, with 99% and 71% probability of being cost‐effective against conventional and lower willingness‐to‐pay thresholds, respectively. A 30% lower DAA price reduced the ICER to €6 900/QALY gained, with 91% probability of being cost‐effective at the lower willingness‐to‐pay threshold. A 60% and 90% lower DAA price had 36% and >99% probability of being cost‐saving, respectively. Sensitivity analyses suggest integrated treatment was cost‐effective at the lower willingness‐to‐pay threshold (>60% probability) across different assumptions on HCV treatment and disease care costs with 30% DAA price reduction, and became cost‐saving with 60%–90% price reductions. Conclusions: Integrated hepatitis C virus treatment for people who inject drugs in community settings is likely cost‐effective compared with standard‐of‐care referral pathways in Norway and may be cost‐saving in settings with particular characteristics. [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.)
Database: Psychology and Behavioral Sciences Collection
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  Data: Cost‐effectiveness of integrated treatment for hepatitis C virus (HCV) among people who inject drugs in Norway: An economic evaluation of the INTRO‐HCV trial.
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  Data: <searchLink fieldCode="AR" term="%22Lim%2C+Aaron+Guanliang%22">Lim, Aaron Guanliang</searchLink><br /><searchLink fieldCode="AR" term="%22Aas%2C+Christer+Frode%22">Aas, Christer Frode</searchLink><br /><searchLink fieldCode="AR" term="%22Çağlar%2C+Ege+Su%22">Çağlar, Ege Su</searchLink><br /><searchLink fieldCode="AR" term="%22Vold%2C+Jørn+Henrik%22">Vold, Jørn Henrik</searchLink><br /><searchLink fieldCode="AR" term="%22Fadnes%2C+Lars+Thore%22">Fadnes, Lars Thore</searchLink><br /><searchLink fieldCode="AR" term="%22Vickerman%2C+Peter%22">Vickerman, Peter</searchLink><br /><searchLink fieldCode="AR" term="%22Johansson%2C+Kjell+Arne%22">Johansson, Kjell Arne</searchLink>
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  Data: <searchLink fieldCode="JN" term="%22Addiction%22">Addiction</searchLink>. Dec2023, Vol. 118 Issue 12, p2424-2439. 16p.
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  Data: <searchLink fieldCode="DE" term="%22Evaluation+of+medical+care%22">Evaluation of medical care</searchLink><br /><searchLink fieldCode="DE" term="%22Narcotics%22">Narcotics</searchLink><br /><searchLink fieldCode="DE" term="%22Disease+progression%22">Disease progression</searchLink><br /><searchLink fieldCode="DE" term="%22Statistics%22">Statistics</searchLink><br /><searchLink fieldCode="DE" term="%22Intravenous+drug+abusers%22">Intravenous drug abusers</searchLink><br /><searchLink fieldCode="DE" term="%22Clinical+trials%22">Clinical trials</searchLink><br /><searchLink fieldCode="DE" term="%22Hepatitis+C%22">Hepatitis C</searchLink><br /><searchLink fieldCode="DE" term="%22Antiviral+agents%22">Antiviral agents</searchLink><br /><searchLink fieldCode="DE" term="%22Health+status+indicators%22">Health status indicators</searchLink><br /><searchLink fieldCode="DE" term="%22Cost+control%22">Cost control</searchLink><br /><searchLink fieldCode="DE" term="%22Community+health+services%22">Community health services</searchLink><br /><searchLink fieldCode="DE" term="%22Randomized+controlled+trials%22">Randomized controlled trials</searchLink><br /><searchLink fieldCode="DE" term="%22Comparative+studies%22">Comparative studies</searchLink><br /><searchLink fieldCode="DE" term="%22Cost+effectiveness%22">Cost effectiveness</searchLink><br /><searchLink fieldCode="DE" term="%22Psychosocial+factors%22">Psychosocial factors</searchLink><br /><searchLink fieldCode="DE" term="%22Quality+of+life%22">Quality of life</searchLink><br /><searchLink fieldCode="DE" term="%22Descriptive+statistics%22">Descriptive statistics</searchLink><br /><searchLink fieldCode="DE" term="%22Integrated+health+care+delivery%22">Integrated health care delivery</searchLink><br /><searchLink fieldCode="DE" term="%22Statistical+sampling%22">Statistical sampling</searchLink><br /><searchLink fieldCode="DE" term="%22Opioid+analgesics%22">Opioid analgesics</searchLink><br /><searchLink fieldCode="DE" term="%22Longitudinal+method%22">Longitudinal method</searchLink>
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  Data: <searchLink fieldCode="DE" term="%22Norway%22">Norway</searchLink>
– Name: Abstract
  Label: Abstract
  Group: Ab
  Data: Background and aims: The INTRO‐HCV randomized controlled trial conducted in Norway over 2017–2019 found that integrated treatment, compared with standard‐of‐care hospital treatment, for hepatitis C virus (HCV) with direct‐acting antivirals (DAAs) improved treatment outcomes among people who inject drugs (PWID). We evaluated cost‐effectiveness of the INTRO‐HCV intervention. Design: A Markov health state transition model of HCV disease progression and treatment with cost‐effectiveness analysis from the health‐provider perspective. Primary cost, utility, and health outcome data were derived from the trial. Costs and health benefits (quality‐adjusted life‐years, QALYs) were tracked over 50 years. Probabilistic and univariate sensitivity analyses investigated DAA price reductions and variations in HCV treatment and disease care cost assumptions, using costs from different countries (Norway, United Kingdom, United States, France, Australia). Setting and participants: PWID attending community‐based drug treatment centers for people with opioid dependence in Norway. Measurements Incremental cost‐effectiveness ratio (ICER) in terms of cost per QALY gained, compared against a conventional (€70 000/QALY) willingness‐to‐pay threshold for Norway and lower (€20 000/QALY) threshold common among high‐income countries. Findings Integrated treatment resulted in an ICER of €13 300/QALY gained, with 99% and 71% probability of being cost‐effective against conventional and lower willingness‐to‐pay thresholds, respectively. A 30% lower DAA price reduced the ICER to €6 900/QALY gained, with 91% probability of being cost‐effective at the lower willingness‐to‐pay threshold. A 60% and 90% lower DAA price had 36% and >99% probability of being cost‐saving, respectively. Sensitivity analyses suggest integrated treatment was cost‐effective at the lower willingness‐to‐pay threshold (>60% probability) across different assumptions on HCV treatment and disease care costs with 30% DAA price reduction, and became cost‐saving with 60%–90% price reductions. Conclusions: Integrated hepatitis C virus treatment for people who inject drugs in community settings is likely cost‐effective compared with standard‐of‐care referral pathways in Norway and may be cost‐saving in settings with particular characteristics. [ABSTRACT FROM AUTHOR]
– Name: AbstractSuppliedCopyright
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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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RecordInfo BibRecord:
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    Identifiers:
      – Type: doi
        Value: 10.1111/add.16305
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      – Code: eng
        Text: English
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        PageCount: 16
        StartPage: 2424
    Subjects:
      – SubjectFull: Evaluation of medical care
        Type: general
      – SubjectFull: Narcotics
        Type: general
      – SubjectFull: Disease progression
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      – SubjectFull: Statistics
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      – SubjectFull: Intravenous drug abusers
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      – SubjectFull: Clinical trials
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      – SubjectFull: Hepatitis C
        Type: general
      – SubjectFull: Antiviral agents
        Type: general
      – SubjectFull: Health status indicators
        Type: general
      – SubjectFull: Cost control
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      – SubjectFull: Community health services
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      – SubjectFull: Randomized controlled trials
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      – SubjectFull: Comparative studies
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      – SubjectFull: Cost effectiveness
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      – SubjectFull: Quality of life
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      – SubjectFull: Norway
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      – TitleFull: Cost‐effectiveness of integrated treatment for hepatitis C virus (HCV) among people who inject drugs in Norway: An economic evaluation of the INTRO‐HCV trial.
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              M: 12
              Text: Dec2023
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