260365 An assessment of the cost-effectiveness of treating chronic hepatitis C virus in injection drug users in Victoria, Australia

Monday, October 29, 2012

Adam Visconti, MPH , School of Medicine, University of California, San Francisco, San Francisco, CA
Alan Shiell, BSc, MSc, PhD , Head Office, Centre of Excellence in Intervention and Prevention Science, Carlton, Australia
Margaret Hellard, PhD, FRACP, FAFPHM , NHRMC Centre for Research Excellence in Injecting Drug Use, Centre for Population Health, Burnet Institute, Melbourne, Australia
Joseph Doyle, MBBS, MSc, FRACP , NHRMC Centre for Research Excellence in Injecting Drug Use, Centre for Population Health, Burnet Institute, Melbourne, Australia
Amanda Weir, BSc, PhD , NHRMC Centre for Research Excellence in Injecting Drug Use, Centre for Population Health, Burnet Institute, Melbourne, Australia
Objectives: To assess the cost-effectiveness and cost-utility of hepatitis C virus (HCV) treatment with pegylated interferon alfa-2a and ribavirin (PEG-IFN/Riba) in current and former injection drug users (IDUs), compared with non-injectors.

Design, setting, and participants: A decision analytic model simulated the lifetime costs and outcomes of four separate treatment options: early treatment with mild fibrosis, standard treatment with moderate fibrosis, late treatment with compensated cirrhosis, and no treatment. Treatment modalities were simulated across separate cohorts of 1000 hypothetical patients with chronic HCV.

Main outcome measures: Incremental costs per quality-adjusted life years (QALYs) gained.

Results: Treatment of current PWID with PEG-IFN/Riba during mild liver fibrosis resulted in a discounted average gain of 1.40 QALYs (95% confidence interval 0.802.06) for an added cost of $AUD 13,096 ($11,311-$14,936) compared to no treatment -- an incremental cost-effectiveness ratio (ICER) of $9,354 per QALY. ($7,251-$15,285) Former IDUs gained an average of 1.40 QALYs (0.74-2.06) for $9,872 ($8,231-$11,535) for early treatment, yielding an ICER of $4,634 per QALY ($4,075-$5,825). Non-injectors gained 2.32 QALYs (1.72-2.71) at a cost of $8,348 ($6,686-$10,012), with an ICER of $3,598 per QALY ($3,601-$3,887). Early treatment was more cost-effective than late treatment in all cohorts. Standard treatment provided superior cost-effectiveness to early treatment in former and non-injector cohorts.

Conclusions: Despite co-morbidities, increased mortality, and generally reduced adherence, treatment of both current and former IDUs is cost-effective. Our cost estimates fall well below unofficial Australian cost-effectiveness thresholds for public subsidies. Scaling-up and expanding treatment for IDUs can be justified on purely economic grounds.

Learning Areas:
Advocacy for health and health education
Biostatistics, economics
Conduct evaluation related to programs, research, and other areas of practice
Provision of health care to the public
Public health or related organizational policy, standards, or other guidelines
Public health or related public policy

Learning Objectives:
Describe how the cost-effectiveness of treating both active and former injection drug users compares to the non-injecting population. Identify the differences in modeling injection drug users compared to the non-injecting population. Analyze why the cost-effectiveness estimates of HCV treatment differ depending on what stage of disease treatment is offered.

Keywords: Economic Analysis, Injecting Drug Use

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I spearheaded this study in the summer of 2011 with the Center for Excellence in Intervention and Prevention Sciences and the Burnet Institute in Melbourne, Australia. As well, I have received training in the economic analysis of public health projects while completing a Masters of Public Health at the University of California, Berkeley.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.