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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.

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IAME, UMR 1137, INSERM, Univ Paris Diderot, Sorbonne Paris Cité, Paris, France.
Laboratoire Paul Painlevé UMR CNRS 8524, UFR de Mathématiques, Université des Sciences et Technologies Lille 1, Cité Scientifique, Villeneuve d'Ascq Cedex, France.
Inserm, LIRIC-UMR995, Univ Lille, Lille, France.
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.
Institut de Veille Sanitaire, Saint-Maurice, France.
LAGA, CNRS, UMR 7539, Université Paris 13, Sorbonne Paris Cité, Villetaneuse, France.
Service des Maladies Infectieuses et Tropicales, Hôpital Bichat Claude Bernard, Paris, France.


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.


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


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