Dr Adam Visconti and colleagues evaluated the cost-effectiveness of hepatitis C virus treatment with pegylated interferon alfa-2a and ribavirin in current and former people who inject drugs.
A decision analytic model simulated the lifetime costs and outcomes of 4 treatment options, including early treatment with mild fibrosis, standard treatment with moderate fibrosis, late treatment with compensated cirrhosis, and no treatment.
The research team simulated treatment modalities across current, former, and never-injector cohorts of 1000 hypothetical patients with chronic hepatitis C virus.
The main outcome measures were incremental costs per quality-adjusted life years gained, and incremental cost-effectiveness ratios were calculated for each cohort.
The doctors noted that treatment of current people who inject drugs during mild fibrosis resulted in a discounted average gain of 1.60 quality-adjusted life years for an added cost of $12 723 compared with no treatment.
This yielded an incremental cost-effectiveness ratios of $7941 per quality-adjusted life years gained.
|Early treatment was more cost-effective|
|Journal of Gastroenterology and Hepatology |
Former people who inject drugs gained 1.80 quality-adjusted life years for $10 441 for early treatment compared with no treatment, resulting in an incremental cost-effectiveness ratios of $5808 per quality-adjusted life years gained.
The research team found that never-injectors gained 2.3 quality-adjusted life years for $9290 compared with no treatment—an incremental cost-effectiveness ratios of $3985 per quality-adjusted life years gained.
Early treatment was more cost-effective than late treatment in all cohorts.
Dr Visconti's team commented "Despite comorbidities, increased mortality, and reduced adherence, treatment of both current and former people who inject drugs is cost-effective."
"Our estimates fall below the unofficial Australian cost-effectiveness threshold of $AUD 50 000 per quality-adjusted life years for public subsidies."
"Scaling up treatment for people who inject drugs can be justified on purely economic grounds."