Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK.
Médecins Sans Frontières (MSF), Nairobi, Kenya.
Addiction. 2022 Feb;117(2):411-424. doi: 10.1111/add.15630. Epub 2021 Jul 28.
Hepatitis C virus (HCV) treatment is essential for eliminating HCV in people who inject drugs (PWID), but has limited coverage in resource-limited settings. We measured the cost-effectiveness of a pilot HCV screening and treatment intervention using directly observed therapy among PWID attending harm reduction services in Nairobi, Kenya.
We utilized an existing model of HIV and HCV transmission among current and former PWID in Nairobi to estimate the cost-effectiveness of screening and treatment for HCV, including prevention benefits versus no screening and treatment. The cure rate of treatment and costs for screening and treatment were estimated from intervention data, while other model parameters were derived from literature. Cost-effectiveness was evaluated over a life-time horizon from the health-care provider's perspective. One-way and probabilistic sensitivity analyses were performed.
Nairobi, Kenya.
PWID.
Treatment costs, incremental cost-effectiveness ratio (cost per disability-adjusted life year averted).
The cost per disability-adjusted life-year averted for the intervention was $975, with 92.1% of the probabilistic sensitivity analyses simulations falling below the per capita gross domestic product for Kenya ($1509; commonly used as a suitable threshold for determining whether an intervention is cost-effective). However, the intervention was not cost-effective at the opportunity cost-based cost-effectiveness threshold of $647 per disability-adjusted life-year averted. Sensitivity analyses showed that the intervention could provide more value for money by including modelled estimates for HCV disease care costs, assuming lower drug prices ($75 instead of $728 per course) and excluding directly-observed therapy costs.
The current strategy of screening and treatment for hepatitis C virus (HCV) among people who inject drugs in Nairobi is likely to be highly cost-effective with currently available cheaper drug prices, if directly-observed therapy is not used and HCV disease care costs are accounted for.
丙型肝炎病毒（HCV）的治疗对于消除注射吸毒者（PWID）体内的 HCV 至关重要，但在资源有限的环境中，其治疗覆盖率有限。我们通过在肯尼亚内罗毕接受减少伤害服务的 PWID 中实施直接观察治疗，对 HCV 筛查和治疗的试点干预措施进行了成本效益评估。
我们利用现有的 HIV 和 HCV 在当前和既往 PWID 中的传播模型，来评估针对 HCV 的筛查和治疗的成本效益，包括与不筛查和治疗相比的预防收益。治疗的治愈率和筛查与治疗的成本均根据干预数据进行估计，而其他模型参数则来自文献。从卫生保健提供者的角度来看，成本效益在终生时间范围内进行评估。我们进行了单因素和概率敏感性分析。
肯尼亚内罗毕。
PWID。
治疗成本、增量成本效益比（每避免一个残疾调整生命年的成本）。
干预措施的每避免一个残疾调整生命年的成本为 975 美元，92.1%的概率敏感性分析模拟结果低于肯尼亚的人均国内生产总值（1509 美元；常用于确定干预措施是否具有成本效益的合适阈值）。然而，根据每避免一个残疾调整生命年 647 美元的基于机会成本的成本效益阈值，该干预措施并不具有成本效益。敏感性分析表明，如果不使用直接观察治疗且考虑 HCV 疾病护理成本（假设药物价格更低，每疗程 75 美元而不是 728 美元），该干预措施可能更具成本效益。
如果使用目前更便宜的药物价格，且不使用直接观察治疗并考虑 HCV 疾病护理成本，那么当前在内罗毕对注射吸毒者进行 HCV 筛查和治疗的策略可能具有很高的成本效益。
