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OBJECTIVES: This study evaluates the cost effectiveness of implementing evidence-based interventions among persons who inject drugs (PWID) in rural settings, where structural barriers and limited resources contribute to disproportionate hepatitis C virus (HCV) burden. Findings are intended to guide equitable implementation planning and resource allocation. METHODS: We developed an economic-epidemiological model to describe HCV transmission among PWID to assess the cost effectiveness of testing, treatment, and harm reduction interventions over a 20-year time horizon. Outcomes included healthcare costs, disability-adjusted life years (DALYs), and incremental cost-effectiveness ratios (ICERs). RESULTS: Expanding testing and treatment was highly cost effective (US1139 per DALY averted), achieved a 90% reduction in HCV incidence by 2035 (within 10 years of the modeled horizon), and averted 45, 126 HCV infections equivalent to protecting one in four people at risk of HCV infection over 20 years. Adding syringe services programs (SSPs, 25% coverage) accelerated incidence reduction and remained cost effective (US2116 per DALY averted). Adding medication-assisted treatment (MAT, 25% coverage) was more costly (US12, 545 per DALY averted) and prevented fewer infections than when adding SSPs. Combining expanded testing and treatment with both MAT and SSPs averted 53, 503 HCV infections, protecting one in three people at risk and achieved a 90% incidence reduction in 6 years for US14, 350 per DALY averted. CONCLUSIONS: Scaling up testing and treatment is a highly cost-effective strategy for rural communities disproportionately affected by HCV. Adding SSPs enhances value and offers an approach to guide policy decisions to reduce disparities where harm reduction infrastructure is limited. Investment in comprehensive, community-centered interventions is essential to advance health equity in HCV elimination efforts.
Tubach et al. (2026) studied this question.