The cost impact of outreach testing and treatment for hepatitis C in an urban Drug Treatment Unit

BACKGROUND & AIMS: In developed countries persons who inject drugs (PWID) represents a significant risk for chronic hepatitis C virus (HCV). It is reported that up to half of persons with chronic HCV remain undiagnosed and reliance on attendance to specialist clinics remain a barrier to treatment. This study assesses the feasibility and cost-effectiveness of outreach screening and treatment within a Drug Treatment Unit (DTU). METHODS: All persons attending a London DTU were offered HCV testing, and where appropriate follow-up and treatment by a specialist nurse at the DTU. Three years of data informed a cost-effective-analysis using a validated Markov model. A hypothetical scenario in which only direct acting antiviral (DAA) treatments were used was also assessed. RESULTS: Of 321 persons eligible, 216 were screened, 89 were HCV positive and 66 had confirmatory evidence of viraemia. All were infected with either HCV genotype 1 or 3. Treatment was initiated in 29 persons, 22 with interferon based and 7 DAA only regimens. Following initial treatment 21 (72%) achieved SVR12. It is estimated that this programme represents an average per-patient cost-saving of £2498 and a quality-adjusted life year (QALY) gain of 4.10 over a lifetime. In a hypothetical scenario of all oral DAA treatment, an incremental cost per QALY of £1029 was estimated. CONCLUSION: This study demonstrates feasibility and cost effectiveness of outreach testing and treatment of hepatitis C within comparable DTU settings. Additional costs of newer DAA therapies would not be prohibitive when considering willingness-to-pay thresholds commonly used by policy makers.