1 Department of Healthcare Policy & Research, Weill Cornell Medical College, NY, NY, USA.
2 Department of Medicine, Section of Infectious Diseases, Boston Medical Center, Boston, MA, USA.
3 Department of Medicine, Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, NY, USA.
4 Department of Medicine, University of South Carolina School of Medicine and Greenville Health System, Greenville, SC, USA.
5 Clemson University School of Health Research, Clemson, SC, USA.
6 Department of Epidemiology, Boston University School of Public Health, Boston, MA, USA.
Many people who inject drugs in the US have chronic Hepatitis C (HCV). Onsite treatment in opiate agonist treatment (OAT) programs addresses HCV treatment barriers, but few evidence-based models exist.
We evaluated the cost-effectiveness of HCV treatment models for OAT patients using data from a randomized trial conducted in Bronx, NY. We used a decision analytic model to compare self-administered individual treatment (SIT), group treatment (GT), directly observed therapy (DOT), and no intervention for a simulated cohort with demographic characteristics of trial participants. We projected long-term outcomes using an established model of HCV disease progression and treatment (HEP-CE). Incremental cost-effectiveness ratios (ICERs) are reported in 2016 US$/QALY, discounted 3% annually, from the healthcare sector and societal perspectives.
For those assigned to SIT, we projected 89% will ever achieve sustained viral response (SVR), 7.21 QALYs, and $245,500 lifetime cost, compared to 22% achieving SVR, 5.49 QALYs, and $161,300 lifetime cost with no intervention. GT was more efficient than SIT resulting in 0.33 additional QALYs and $14,100 lower lifetime costs per person, with an ICER of $34,300/QALY compared to no intervention. DOT was slightly more effective and costly than GT, with an ICER >$100,000/QALY compared to GT. In probabilistic sensitivity analyses GT and DOT were preferred in 91% of simulations at a threshold of <$100,000/QALY; conclusions were similar from the societal perspective.
All models were associated with high rates of achieving SVR compared to standard care. GT and DOT treatment models should be considered cost-effective alternatives to SIT.