The cost benefits for health system in treating PWIDs with chronic hepatitis C: evidence form real practice
Abstract
Background
The World Health Organization (WHO) sets the goal to eliminate the hepatitis C virus (HCV) worldwide by 2030 (WHO, 2017). This goal is achievable thanks to the introduction in the clinical practice of direct anti-viral drugs (DAAs) that are able also in drug users to heal the disease (Nava et al., 2018) with significant impacts on reducing healthcare costs. The aim of this study was to collect from a population consisting of HCV-positive patients attending outpatient services for addiction treatment (Servizi per le Dipendenze – Ser.D.) of the metropolitan Milan area the public health and the economic benefits in terms of direct health costs saved for the patients included in an integrated and effective “linkage to care” patient’s journey.
Methods
The sample included 274 PWIDs–HCV infected patients took in charge over one year (January – December 2017). We measured the rate of subjects screened for HCV Ab, selected the HCV-positive subjects eligible for a specific antiviral treatment and calculated the costs derived by their management, comparing them subsequently to the direct health costs to be incurred in case of non-treatment. Finally, we calculated the cost of HCV positive patients included in an effective model of “linkage to care” considered as best practice.
Results
The seroprevalence in 274 HCV-positive patients with injective behaviour (21% of the total) was 94% (n = 257). Of the positive patients 163 (59%) were non-treated and 65 (24%) were treated. Direct costs per treated patient (excluding drugs expenditure) ranged from € 1,297 to € 1,540 based on the patient’s complexity while mean cost per patient was € 1,418. The above costs may be reduced if the patients are included in an effective model of “linkage of care” that includes also measures of harm reduction able to decrease the rate of reinfection. Since literature indicates that injecting drug use is responsible for 23% of new HCV infections and that each HCV+ PWID can infect at least 20 others within the first 3 years of infection, our result suggest that a PWID treated can save about € 30,000 of direct healthcare costs over the next 3 years.
Conclusion
The treatment of a PWID with HCV infection can significantly reduce not only the individual health costs but also the community costs. Finally, our study shows that in real practice, the integrated and effective patient’s journey, including also harm reduction measures, can be both effective and cost saving for the whole health care system.