The cost impact of outreach testing and treatment for hepatitis C in an urban Drug Treatment Unit

Summary People who inject drugs (PWID) are a key high‐risk group for Hepatitis C Virus (HCV) infection due to the sharing of needles and drug‐preparation equipment. However, only approximately 50% of PWID are currently screened for HCV in Switzerland. At present, screening of PWID occurs in general practice via venepuncture. Compared to venepuncture, screening via rapid antibody saliva and dried blood spot (DBS) tests is well adapted to PWID, who typically have difficult venous access. The cost‐effectiveness of an increased access screening programme of PWID (increased screening using rapid antibody saliva tests and DBS tests [semi‐quantitative viraemia and viral genotype]) was analysed through a decision tree screening model combined with the outputs of a Markov treatment model. Sensitivity and scenario analyses examined the uncertainty of results. At a willingness to pay (WTP) threshold of CHF 100 000 (USD 105 000) per quality‐adjusted life year (QALY), the increased access screening programme was cost‐effective compared to current screening, with a base case incremental cost‐effectiveness ratio of CHF 7 940 (USD 8337) per QALY. The net monetary benefit was CHF 959 802 668 (USD 1 007 792 801) for the PWID population and CHF 94 469 (USD 99 192) per person. The increased access screening programme had a 97.0% probability of being cost‐effective compared to the current screening method at the WTP threshold of CHF 100 000 (USD 105 000). The results showed an increased access screening programme that uses tests which are better suited to the PWID population to be more cost‐effective, due to the increased uptake that rapid antibody saliva and DBS tests generate.

Section: Discussionsupporting

confidence: 89%

Increasing hepatitis C virus screening in people who inject drugs in Switzerland using rapid antibody saliva and dried blood spot testing: A cost‐effectiveness analysis

Girardin

Hearmon

Negro³

et al. 2018

“…Only direct medical costs in UK pounds sterling of each state were considered, and disease‐associated costs were inflated to 2018 prices using the health and social care index (Table C) . In keeping with similar UK‐based studies, all costs were discounted annually by 3.5% . A cost per case was calculated for the intervention, which included testing equipment, pharmacist time, further investigations for positive cases, follow‐up with a specialist and the cost of treatment (Table ).…”

Section: Methodsmentioning

confidence: 99%

“…36 In keeping with similar UK-based studies, all costs were discounted annually by 3.5%. 25,37 A cost per case was calculated for the intervention, which included testing equipment, pharmacist time, further investigations for positive cases, follow-up with a specialist and the cost of treatment (Table 2).…”

Section: Costs Of the Interventionmentioning

confidence: 99%

The testing of people with any risk factor for hepatitis C in community pharmacies is cost‐effective

Buchanan

Cooper

Grellier

et al. 2019

New antiviral drugs with high efficacy mean the hepatitis C virus (HCV) can now be eliminated. To achieve this, it is necessary to identify undiagnosed cases of HCV. However, the costs of testing should be considered when judging the overall cost‐effectiveness of treatment. This study describes the cost‐effectiveness of a community pharmacy testing service in a population of people at risk of HCV living on the Isle of Wight (United Kingdom). Dry blood spot testing was conducted in anyone with a known risk factor for HCV in 20 community pharmacies. The outcomes and costs were entered into a Markov model. Cost and health utilities from the model were used to calculate an incremental cost‐effectiveness ratio (ICER). In 24 months, 186 tests were conducted, 13 were positive for HCV RNA and six of these (46%) received treatment during the follow‐up period. All achieved a sustained virological response at 3 months. The overall cost of the testing and treatment intervention was £242 183, and the ICER for the service was £3689 per quality‐adjusted life year (QALY) gained. If screening had been restricted to just people with a history of injecting drug use (PWID) the ICER would have been £4865 per QALY gained. The service was effective at identifying people with HCV infection, and despite the additional cost of targeted testing, its cost‐effectiveness was below the commonly accepted thresholds. In this setting, restricting targeted testing to PWID would not improve the cost‐effectiveness.

“…If the UK is to achieve WHO targets, engaging, testing and treating, this hard‐to‐reach cohort is essential. In the UK, intermittent HCV outreach programmes (from hospitals into local drug and alcohol treatment [DAT] services) have been shown to be safe, cost effective, with good uptake and treatment outcomes similar to, and in some cases better than, secondary care …”

Section: Introductionmentioning

confidence: 99%

Improving access to care for people who inject drugs: Qualitative evaluation of project ITTREAT—An integrated community hepatitis C service

Phillips

Schulkind

O’Sullivan

et al. 2019

Achieving hepatitis C virus (HCV) elimination by 2030 requires an increased linkage to care for people who inject drugs (PWID). Project ITTREAT was established to mitigate barriers to HCV care by providing an integrated service within a local drug and alcohol treatment centre. This study aimed to explore the experiences of clients and staff involved in Project ITTREAT and assess the facilitators and barriers to a community-based HCV service. Between October 2014 and April 2016, drug and alcohol treatment attendees were interviewed using one-to-one semi-structured interviews.Drug and alcohol treatment staff took part in focus groups. All data were recorded, transcribed verbatim and analysed using thematic content analysis. Fifteen drug and alcohol treatment attendees with current/previous HCV infection were interviewed, and 15 staff members contributed across two focus groups. Drug and alcohol treatment staff and attendees reported that Project ITTREAT facilitated access to HCV care by mitigating previous negative hospital-based experiences. Other key facilitators were positive narratives around HCV care, and drug and alcohol treatment attendees being well engaged in their drug/alcohol recovery. Barriers included a lack of stability in drug and alcohol treatment attendees, negative discourse around testing/ treatment and stigma associated with attending the drug and alcohol treatment to access HCV treatment in some who had successfully achieved drug rehabilitation.Our findings indicate the positive impact of an integrated and personalized community-based service delivered by a dedicated hepatitis nurse. This played a crucial role in reducing barriers to HCV care for PWID. Our work also highlights areas for future investment including non-DAT-based community services and increasing awareness of new treatments amongst this cohort. K E Y W O R D S barriers, community HCV service, facilitators, hepatitis C virus, staff/client experience, substance misuse | 177 PHILLIPS et aL.