Cost effectiveness of simplified HCV screening-and-treatment interventions for people who inject drugs in Dar-es-Salaam, Tanzania

• Published in: The International journal of drug policy Vol. 99; p. 103458
• Main Authors: Mohamed, Zameer, Scott, Nick, Nayagam, Shevanthi, Rwegasha, John, Mbwambo, Jessie, Thursz, Mark R, Brown, Ashley S, Hellard, Margaret, Lemoine, Maud
• Format: Journal Article
• Language: English
• Published: Netherlands Elsevier B.V 01.01.2022; Elsevier Science Ltd
• Subjects: Access; Antiviral Agents - therapeutic use; Antiviral drugs; Comparative studies; Cost analysis; Cost effectiveness; Cost-Benefit Analysis; Disability adjusted life years; Disease; Drug abuse; Drug policy; Drug use; Drug Users; Effectiveness; Harm reduction; HCV; Health care expenditures; Hepatitis; Hepatitis C; Hepatitis C - diagnosis; Hepatitis C - drug therapy; Hepatitis C, Chronic - drug therapy; Humans; Integrated care; Intervention; Medical diagnosis; Medical screening; Medical treatment; Opioids; Outreach programs; People who inject drugs (PWID); Quality adjusted life years; Sensitivity analysis; Sub-Saharan Africa (SSA); Substance Abuse, Intravenous - complications; Substance Abuse, Intravenous - drug therapy; Synergism; Tanzania; Thresholds; Viruses; Willingness to pay; Tanzania; HCV; Sub-Saharan Africa (SSA); Cost effectiveness; People who inject drugs (PWID)
• ISSN: 0955-3959; 1873-4758
• DOI: 10.1016/j.drugpo.2021.103458

Compared to other countries in sub-Saharan Africa, Tanzania has a relatively progressive illicit drug harm reduction (HR) policy, through a predominantly opioid substitution therapy-based programme. However, access to hepatitis C virus (HCV) diagnosis and curative direct acting antiviral therapy remains elusive. We developed a cost-effectiveness model to evaluate a simplified HCV screening-and-treatment intervention amongst PWID in Dar-es-Salaam, Tanzania. A decision tree and Markov state transition model compared existing practice (no access to HCV viral confirmation and treatment) with the integration of point-of-care HCV screening and treatment within (1) existing HR services and (2) expansion to include PWID not currently engaged in HR. Outcome measures were screening, treatment, HR and disease-related costs per PWID, quality-adjusted life years (QALY) and disability adjusted life years (DALY). Cost-effectiveness was evaluated from a healthcare payer's perspective over a 30-year time horizon over a range of willingness-to-pay thresholds (USD$273 to USD$1,050). Both deterministic and probabilistic sensitivity analyses have been conducted. Assuming a chronic HCV prevalence of 18.8%, screening-and-treatment in existing HR settings resulted in an ICER per QALY-gained and DALY averted of USD$633 and USD$1,161, respectively. Expanding to include an outreach programme for unengaged PWID yielded an ICER per QALY-gained and DALY-averted of USD$4,091 and USD$10,288. Factors affecting the sensitivity of the ICER value included the cost of HR and the health utility of non-cirrhotic disease states. Simplified HCV screening and treatment of PWID has the potential to be cost-effective in Dar-es-Salaam, Tanzania. In practice, synergism of human and financial resources with established health programmes may offer a pragmatic solution to minimise operational costs.