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

Author:

Lim Aaron Guanliang1ORCID,Aas Christer Frode234ORCID,Çağlar Ege Su23,Vold Jørn Henrik234,Fadnes Lars Thore23,Vickerman Peter1ORCID,Johansson Kjell Arne23

Affiliation:

1. Population Health Sciences, Bristol Medical School University of Bristol Bristol UK

2. Bergen Addiction Research, Department of Addiction Medicine Haukeland University Hospital Bergen Norway

3. Department of Global Public Health and Primary Care University of Bergen Bergen Norway

4. Division of Psychiatry Haukeland University Hospital Bergen Norway

Abstract

AbstractBackground and aimsThe 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.DesignA 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 participantsPWID attending community‐based drug treatment centers for people with opioid dependence in Norway.MeasurementsIncremental 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.FindingsIntegrated 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.ConclusionsIntegrated 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.

Funder

Norges Forskningsråd

Helse Vest

Haukeland Universitetssjukehus

University of Bristol

Wellcome Trust

NIHR Nottingham Biomedical Research Centre

Publisher

Wiley

Subject

Psychiatry and Mental health,Medicine (miscellaneous)

Cited by 1 articles. 订阅此论文施引文献 订阅此论文施引文献,注册后可以免费订阅5篇论文的施引文献,订阅后可以查看论文全部施引文献

1. Cost effectiveness of hepatitis C direct acting agents;Expert Review of Pharmacoeconomics & Outcomes Research;2024-05-03

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