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

• Published in: Journal of viral hepatitis Vol. 25; no. 10; pp. 1197 - 1207
• Main Authors: Cousien, A., Tran, V. C., Deuffic‐Burban, S., Jauffret‐Roustide, M., Mabileau, G., Dhersin, J.‐S., Yazdanpanah, Y.
• Format: Journal Article
• Language: English
• Published: England Wiley Subscription Services, Inc 01.10.2018; Wiley-Blackwell
• Subjects: Antiviral agents; cost‐effectiveness; Diagnosis; direct‐acting antiviral; Drug screening; Fibrosis; Hepatitis; Hepatitis C; Humanities and Social Sciences; Infections; Life expectancy; Life span; modelling; Opioids; people who inject drugs; France; cost-effectiveness; direct-acting antiviral; modelling; hepatitis C; people who inject drugs
• ISSN: 1352-0504; 1365-2893
• DOI: 10.1111/jvh.12919

Summary 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.