HCV Antivirals Cost-Effective for Injecting Drug Users

Antivirals are cost-effective for injecting drug users where the chronic prevalence of hepatitis C virus infection is less than 60 percent, according to a study published in the January issue of Hepatology.

Antivirals are cost-effective for injecting drug users (IDUs) where the chronic prevalence of hepatitis C virus (HCV) infection is less than 60 percent, according to a study published in the January issue of Hepatology.

Natasha K. Martin, D.Phil., of the University of Bristol in the United Kingdom, and colleagues compared the cost-effectiveness of providing antiviral treatment for IDUs, ex or non-IDUs, or no treatment. They developed a model of HCV transmission and disease progression which incorporated assumptions including: a specified number of antiviral treatments to be given at the mild HCV stage over a period of 10 years, no retreatment for those who failed treatment, potential reinfection, and scenarios for baseline IDU HCV chronic prevalence of 20, 40, and 60 percent. Long-term costs and outcomes measured in quality adjusted life years (QALYs) were performed and the incremental cost-effectiveness ratio (ICER) was compared for no treatment, antiviral treatment for IDUs, and antiviral treatment for ex/non-IDUs.

The researchers found that, in the 20 and 40 percent baseline chronic prevalence settings, antiviral treatment for IDUs is the most cost-effective option compared with no treatment (ICER, £521 and £2,539 per QALY saved, respectively). Treatment of ex/non-IDUs dominated here. Treating ex/non-IDUs was slightly more likely to be cost-effective at a baseline chronic prevalence of 60 percent, and treating IDUs dominated due to high reinfection.

“Treating chronic HCV infection among injectors and ex- or noninjectors is cost-effective, but treating injectors may be more cost-effective when the chronic HCV prevalence among IDU is below 60 percent,” the authors write.