An intensive model of care for hepatitis C virus screening and treatment with direct-acting antivirals in people who inject drugs in Nairobi, Kenya: a model-based cost-effectiveness analysis

Nyashadzaishe Mafirakureva, Jack Stone, Hannah Fraser, Yvonne Nzomukunda, Aron Maina, Angela W. Thiong'o, Kibango Walter Kizito, Esther W.K. Mucara, C. Inés González Diaz, Helgar Musyoki, Bernard Mundia, Peter Cherutich, Mercy Nyakowa, John Lizcano, Nok Chhun, Ann Kurth, Matthew J. Akiyama, Wanjiru Waruiru, Parinita Bhattacharjee, Charles ClelandDmytro Donchuk, Niklas Luhmann, Anne Loarec, David Maman, Josephine Walker, Peter Vickerman

Research output: Contribution to journalArticlepeer-review

3 Scopus citations

Abstract

Background and aims: Hepatitis C virus (HCV) treatment is essential for eliminating HCV in people who inject drugs (PWID), but has limited coverage in resource-limited settings. We measured the cost-effectiveness of a pilot HCV screening and treatment intervention using directly observed therapy among PWID attending harm reduction services in Nairobi, Kenya. Design: We utilized an existing model of HIV and HCV transmission among current and former PWID in Nairobi to estimate the cost-effectiveness of screening and treatment for HCV, including prevention benefits versus no screening and treatment. The cure rate of treatment and costs for screening and treatment were estimated from intervention data, while other model parameters were derived from literature. Cost-effectiveness was evaluated over a life-time horizon from the health-care provider's perspective. One-way and probabilistic sensitivity analyses were performed. Setting: Nairobi, Kenya. Population: PWID. Measurements: Treatment costs, incremental cost-effectiveness ratio (cost per disability-adjusted life year averted). Findings: The cost per disability-adjusted life-year averted for the intervention was $975, with 92.1% of the probabilistic sensitivity analyses simulations falling below the per capita gross domestic product for Kenya ($1509; commonly used as a suitable threshold for determining whether an intervention is cost-effective). However, the intervention was not cost-effective at the opportunity cost-based cost-effectiveness threshold of $647 per disability-adjusted life-year averted. Sensitivity analyses showed that the intervention could provide more value for money by including modelled estimates for HCV disease care costs, assuming lower drug prices ($75 instead of $728 per course) and excluding directly-observed therapy costs. Conclusions: The current strategy of screening and treatment for hepatitis C virus (HCV) among people who inject drugs in Nairobi is likely to be highly cost-effective with currently available cheaper drug prices, if directly-observed therapy is not used and HCV disease care costs are accounted for.

Original languageEnglish (US)
Pages (from-to)411-424
Number of pages14
JournalAddiction
Volume117
Issue number2
DOIs
StatePublished - Feb 2022

ASJC Scopus subject areas

  • Medicine (miscellaneous)
  • Psychiatry and Mental health

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