The cost-effectiveness of an HCV outreach intervention for at-risk populations in London, UK

Abstract

Background HCV disproportionately affects marginalized communities such as homeless populations and people who inject drugs (PWID), posing a challenge to traditional health services. The HepFriend initiative in London is a model of care utilizing HCV outreach screening and peer support to link vulnerable individuals to HCV treatment in secondary care. Objectives To assess the cost-effectiveness of the HepFriend initiative from a healthcare provider perspective, compared with standard-of-care pathways (consisting of testing in primary care and other static locations, including drug treatment centres, and linkage to secondary care). Methods Cost-effectiveness analysis using a dynamic HCV transmission and disease progression model among PWID and those who have ceased injecting, including housing status and drug treatment service contact. The model was parameterized using London-specific surveillance and survey data, and primary intervention cost and effectiveness data (September 2015 to June 2018). Out of 461 individuals screened, 197 were identified as HCV RNA positive, 180 attended secondary care and 89 have commenced treatment to date. The incremental cost-effectiveness ratio (ICER) was determined using a 50 year time horizon. Results For a willingness-to-pay threshold of £20000 per QALY gained, the HepFriend initiative is cost-effective, with a mean ICER of £9408/QALY, and would become cost saving at 27% (£10525 per treatment) of the current drug list price. Results are robust to variations in intervention costs and model assumptions, and if treatment rates are doubled the intervention becomes more cost-effective (£8853/QALY). Conclusions New models of care that undertake active case-finding with enhanced peer support to improve testing and treatment uptake amongst marginalized and vulnerable groups could be highly cost-effective and possibly cost saving.

From peer-based to peer-led: redefining the role of peers across the hepatitis C care pathway: HepCare Europe

“…A cost-effectiveness analysis of this intervention in comparison with current care pathways was carried out by the University of Bristol. Using the full list price for drug treatment it was found to be cost-effective at a willingness-to-pay threshold of £20000 per quality-adjusted life year (QALY) gained 38 . Furthermore, Ward et al 38 .…”

“…Using the full list price for drug treatment it was found to be cost-effective at a willingness-to-pay threshold of £20000 per quality-adjusted life year (QALY) gained 38 . Furthermore, Ward et al 38 . found this intervention to be cost-saving at 45% of the UK list price for sofosbuvir and velpatasvir (£17539 per course).…”

Cost‐effectiveness of the HepCATT intervention in specialist drug clinics to improve case‐finding and engagement with HCV treatment for people who inject drugs in England

“…The analysis follows broad best practise in clearly describing all details of the modelling, giving details of the derivation of all model parameters, calibrating and validating the model against available data, and incorporating parameter uncertainty (21,22). The analysis did not follow a pre-registered analysis plan but used similar methods to our previous studies (9,23).…”

HepCare Europe: a new user-friendly hepatitis C care service model. What have we learned? What are the remaining challenges?

“…The HepCost study aims to assess the cost-effectiveness of combining HCV outreach screening, treatment and peer support (i.e. the HepCare service) in London from a healthcare perspective in comparison with current care pathways; namely, testing in locations such as drug treatment centres, and linkage to secondary care 19 . Clearly, this study is extremely important as payers will need to be convinced that new models of care are cost-effective in order to promote widespread implementation.…”