The cost-effectiveness of an HCV outreach intervention for at risk populations in London
Background and Aims: Hepatitis C virus (HCV) disproportionately affects marginalised communities such as homeless populations and people who inject drugs (PWID), posing a challenge to traditional health services. The HepFriend initiative in London is a model of care utilising HCV outreach screening and peer support to link vulnerable individuals to HCV treatment in secondary care. The aim of the study is to assess the cost-effectiveness of the HepFriend initiative from a healthcare provider perspective, compared to standard-of-care pathways (consisting of testing in primary care and other static locations, including drug treatment centres, and linkage to secondary care).
Method:Cost-effectiveness analysis using a dynamic HCV transmission and disease progression model among PWID and those who have ceased injecting, including housing status and drug treatment service contact, parameterised using London specific surveillance and survey data, and primary intervention cost and effectiveness data (September 2015 to June 2018). Out of 461 individuals screened, 200 were identified as HCV RNA positive, 198 attended secondary care and 99 have commenced treatment to date. The incremental cost-effectiveness ratio (ICER) was determined using a 50-year time horizon.
Results:For a £20,000 per quality adjusted life year (QALY) gained willingness-to-pay threshold, the HepFriend initiative was cost-effective, mean ICER of £8,880 per QALY, and would become cost-saving at 45% (£17,536 per treatment) of the current drug list price. Results are robust to variations in intervention costs and model assumptions.
Conclusion:New models of care that undertake active case-finding with enhanced peer-support to improve testing and treatment uptake amongst marginalised and vulnerable groups could be highly cost-effective and possibly cost-saving.