Cost-effectiveness of hepatitis C virus treatment models for people who inject drugs in opioid agonist treatment programs

Sarah Gutkind, Bruce R. Schackman, Jake R. Morgan, Jared A. Leff, Linda Agyemang, Sean M. Murphy, Matthew J. Akiyama, Brianna L. Norton, Alain H. Litwin, Benjamin P. Linas

Research output: Contribution to journalArticle

3 Scopus citations

Abstract

Background: Many people who inject drugs in the United States have chronic hepatitis C virus (HCV). On-site treatment in opiate agonist treatment (OAT) programs addresses HCV treatment barriers, but few evidence-based models exist. Methods: We evaluated the cost-effectiveness of HCV treatment models for OAT patients using data from a randomized trial conducted in Bronx, New York. We used a decision analytic model to compare self-administered individual treatment (SIT), group treatment (GT), directly observed therapy (DOT), and no intervention for a simulated cohort with the same demographic characteristics of trial participants. We projected long-term outcomes using an established model of HCV disease progression and treatment (hepatitis C cost-effectiveness model: HEP-CE). Incremental cost-effectiveness ratios (ICERs) are reported in 2016 US$/quality-adjusted life years (QALY), discounted 3% annually, from the healthcare sector and societal perspectives. Results: For those assigned to SIT, we projected 89% would ever achieve a sustained viral response (SVR), with 7.21 QALYs and a $245 500 lifetime cost, compared to 22% achieving SVR, with 5.49 QALYs and a $161 300 lifetime cost, with no intervention. GT was more efficient than SIT, resulting in 0.33 additional QALYs and a $14 100 lower lifetime cost per person, with an ICER of $34 300/QALY, compared to no intervention. DOT was slightly more effective and costly than GT, with an ICER > $100 000/QALY, compared to GT. In probabilistic sensitivity analyses, GT and DOT were preferred in 91% of simulations at a threshold of <$100 000/QALY; conclusions were similar from the societal perspective. Conclusions: All models were associated with high rates of achieving SVR, compared to standard care. GT and DOT treatment models should be considered as cost-effective alternatives to SIT.

Original languageEnglish (US)
Pages (from-to)1397-1405
Number of pages9
JournalClinical Infectious Diseases
Volume70
Issue number7
DOIs
StatePublished - Mar 17 2020

Keywords

  • directly observed therapy
  • economic evaluation
  • opioid use disorder
  • simulation model
  • viral hepatitis

ASJC Scopus subject areas

  • Microbiology (medical)
  • Infectious Diseases

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    Gutkind, S., Schackman, B. R., Morgan, J. R., Leff, J. A., Agyemang, L., Murphy, S. M., Akiyama, M. J., Norton, B. L., Litwin, A. H., & Linas, B. P. (2020). Cost-effectiveness of hepatitis C virus treatment models for people who inject drugs in opioid agonist treatment programs. Clinical Infectious Diseases, 70(7), 1397-1405. https://doi.org/10.1093/cid/ciz384