BACKGROUND AND AIMS People who inject drugs (PWID) are at high risk of Hepatitis C virus (HCV) infection; however ~50% are undiagnosed in England and linkage-to-care is poor. This study investigated the cost-effectiveness of an intervention (HepCATT) to improve case-finding and referral to HCV treatment compared with standard-of-care pathways in drug treatment centres (DTCs) in England. DESIGN HCV transmission and disease progression model with cost-effectiveness analysis using a health-care perspective. Primary outcome and cost data from the HepCATT study parameterised the intervention, suggesting HepCATT increased HCV testing in DTCs 2.5-fold and engagement onto the HCV treatment pathway 10-fold. Model was used to estimate the decrease in HCV infections and HCV-related deaths from 2016, with costs and health benefits (quality-adjusted life-years or QALYs) tracked over 50 years. Univariable and probabilistic sensitivity analyses (PSA) were undertaken. SETTING England specific epidemic with 40% prevalence of chronic HCV among PWID. PARTICIPANTS PWID attending DTCs. INTERVENTION Nurse facilitator in DTCs to improve the HCV care pathway from HCV case-finding to referral and linkage to specialist care. Comparator was the standard-of-care HCV care pathway. MEASUREMENTS Incremental cost-effectiveness ratio (ICER) in terms of cost per QALY gained through improved case-finding. FINDINGS Over 50-years per 1000 PWID, the HepCATT intervention could prevent 75 (95% central interval 37-129) deaths and 1,330 (827-2,040) or 51% (30-67%) of all new infections. The mean ICER was £7,986 per QALY gained, with all PSA simulations being cost-effective at a £20,000 per QALY willingness-to-pay threshold. Univariable sensitivity analyses suggest the intervention would become cost-saving if the cost of HCV treatment reduces to £3,900. If scaled up to all PWID in England, the intervention would cost £8.8 million and decrease incidence by 56% (33-70%) by 2030. CONCLUSIONS Increasing Hepatitis C virus (HCV) infection case-finding and treatment referral in drug treatment centres could be a highly cost-effective strategy for decreasing HCV incidence among people who inject drugs.

中文翻译：

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HepCATT 干预专科药物诊所改善英格兰注射吸毒者病例发现和 HCV 治疗参与的成本效益


背景和目标 注射吸毒者 (PWID) 感染丙型肝炎病毒 (HCV) 的风险很高；然而，在英格兰，约 50% 的患者未得到诊断，且与护理的联系很差。本研究调查了与英格兰戒毒中心 (DTC) 的标准护理途径相比，改善病例发现和转诊 HCV 治疗的干预措施 (HepCATT) 的成本效益。从医疗保健角度设计 HCV 传播和疾病进展模型，并进行成本效益分析。 HepCATT 研究的主要结果和成本数据参数化了干预措施，表明 HepCATT 将 DTC 中的 HCV 检测提高了 2.5 倍，并将 HCV 治疗途径的参与度提高了 10 倍。该模型用于估计自 2016 年以来 HCV 感染和 HCV 相关死亡的减少情况，并跟踪了 50 多年的成本和健康效益（质量调整生命年或 QALY）。进行了单变量和概率敏感性分析（PSA）。设置英格兰特定流行病，吸毒者中慢性 HCV 患病率为 40%。参与者 注射吸毒者参加 DTC。干预 DTC 中的护士协调员，以改善从 HCV 病例发现到转诊以及与专科护理的联系的 HCV 护理途径。对照是 HCV 护理标准护理途径。测量 通过改进病例发现获得的每 QALY 成本的增量成本效益比 (ICER)。研究结果 50 多年来，每 1000 名吸毒者中，HepCATT 干预可预防 75 例（95% 中心区间 37-129）例死亡和 1,330 例（827-2,040 例）或所有新发感染的 51%（30-67%）例。每获得 QALY 的平均 ICER 为 7,986 英镑，所有 PSA 模拟在每 QALY 支付意愿为 20,000 英镑的情况下都具有成本效益。 单变量敏感性分析表明，如果 HCV 治疗成本降低至 3,900 英镑，干预措施将节省成本。如果扩大到英格兰所有吸毒者，干预措施将花费 880 万英镑，到 2030 年，发病率将降低 56% (33-70%)。 结论 增加戒毒治疗中心的丙型肝炎病毒 (HCV) 感染病例发现和治疗转诊可能是降低注射吸毒者丙型肝炎病毒发病率的一种极具成本效益的策略。