Can real-world scaling up HCV treatment in people who inject drugs be cost-saving: an economic modelling study in the UK

INTRODUCTION: UK is one of a few countries that are likely to meet WHO HCV elimination targets of reducing incidence to <2 per 100 person years in People Who Inject Drugs (PWID), but the economic case may be important for investment elsewhere and in future in UK. We illustrate the impact of real-world scaled-up HCV treatment to assess under what drug treatment costs could the investment be cost-saving. METHODS: We utilised a mathematical and economic model, calibrated to public health surveillance data and HCV testing and treatment scale-up from 4 regions in UK, that projects trends in HCV prevalence and incidence among PWID from 2016 to 2030, and deaths and incremental cost-effectiveness ratio (ICER) from 2016 until 2065, compared to counterfactual of no community and prison testing and treatment scale-up. We vary HCV drug price from £1000 to £10,000 per person treated and estimate the % of runs that are cost-saving for each price. RESULTS: Scaling up HCV treatment in PWID is estimated to avert on average 35-60% of HCV infections over 2016-2030 in the four regions compared to a counterfactual of no treatment scale-up. Over 50 years the intervention would prevent 13 to 34% of deaths assuming current HCV treatment rates continue. The ICER is cost-saving from <£1000 to £5000 across the four regions with the average (weighted by estimated number of PWID in each region) of these threshold costs at approximately £3000 per course. The majority of costs from HCV (∼ 78% before treatment scale-up) and contribution to reducing burden is due to severe liver disease (cirrhosis and decompensated cirrhosis). CONCLUSION: Scaling up HCV testing and treatment to meet WHO elimination targets is highly cost-effective and could be cost-saving at realistic discounted drug costs. The economic case for HCV elimination can be made for countries that are not yet on track.