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J Viral Hepat. 2018 Oct;25(10):1197-1207. doi: 10.1111/jvh.12919. Epub 2018 May 9.

Effectiveness and cost-effectiveness of interventions targeting harm reduction and chronic hepatitis C cascade of care in people who inject drugs: The case of France.

Author information

1
IAME, UMR 1137, INSERM, Univ Paris Diderot, Sorbonne Paris Cité, Paris, France.
2
Laboratoire Paul Painlevé UMR CNRS 8524, UFR de Mathématiques, Université des Sciences et Technologies Lille 1, Cité Scientifique, Villeneuve d'Ascq Cedex, France.
3
Inserm, LIRIC-UMR995, Univ Lille, Lille, France.
4
CERMES3: Centre de Recherche Médecine, Sciences, Santé, Santé Mentale et Société, (INSERM U988/UMR CNRS8211/Université Paris Descartes, Ecole des Hautes Etudes en Sciences Sociales), Paris, France.
5
Institut de Veille Sanitaire, Saint-Maurice, France.
6
LAGA, CNRS, UMR 7539, Université Paris 13, Sorbonne Paris Cité, Villetaneuse, France.
7
Service des Maladies Infectieuses et Tropicales, Hôpital Bichat Claude Bernard, Paris, France.

Abstract

Direct-acting antivirals (DAAs) represent an opportunity to improve hepatitis C virus (HCV) care cascade. This combined with improved harm reduction interventions may lead to HCV elimination especially in people who inject drugs (PWID). We assessed the effectiveness/cost-effectiveness of improvements in harm reduction and chronic hepatitis C (CHC) care cascade in PWID in France. We used a dynamic model of HCV transmission and CHC natural history and evaluated the following: improved needle/syringe programmes-opioid substitution therapies, faster diagnosis/linkage to care, earlier treatment initiation, alone and in combination among active PWID (mean age = 36). Outcomes were as follows: life expectancy in discounted quality-adjusted life years (QALYs); direct lifetime discounted costs; incremental cost-effectiveness ratio (ICER); number of infections/reinfections. Under the current practice, life expectancy was 15.846 QALYs, for a mean lifetime cost of €20 762. Treatment initiation at F0 fibrosis stage alone was less effective and more costly than faster diagnosis/linkage to care combined with treatment initiation at F0, which increased life expectancy to 16.694 QALYs, decreased new infections by 37%, with a ICER = €5300/QALY. Combining these interventions with harm reduction improvements was the most effective scenario (life expectancy = 16.701 QALYs, 41% decrease in new infections) but was not cost-effective (ICER = €105 600/QALY); it became cost-effective with higher initial HCV incidence rates and lower harm reduction coverage than in our base-case scenario. This study illustrated the high effectiveness, and cost-effectiveness, of a faster diagnosis/linkage to care together with treatment from F0 with DAAs. This "Test and treat" strategy should play a central role both in improving the life expectancies of HCV-infected patients, and in reducing HCV transmission.

KEYWORDS:

cost-effectiveness; direct-acting antiviral; hepatitis C; modelling; people who inject drugs

PMID:
29660211
DOI:
10.1111/jvh.12919

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