Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK.
Bergen Addiction Research, Department of Addiction Medicine, Haukeland University Hospital, Bergen, Norway.
Addiction. 2023 Dec;118(12):2424-2439. doi: 10.1111/add.16305. Epub 2023 Jul 29.
The INTRO-HCV randomized controlled trial conducted in Norway over 2017-2019 found that integrated treatment, compared with standard-of-care hospital treatment, for hepatitis C virus (HCV) with direct-acting antivirals (DAAs) improved treatment outcomes among people who inject drugs (PWID). We evaluated cost-effectiveness of the INTRO-HCV intervention.
A Markov health state transition model of HCV disease progression and treatment with cost-effectiveness analysis from the health-provider perspective. Primary cost, utility, and health outcome data were derived from the trial. Costs and health benefits (quality-adjusted life-years, QALYs) were tracked over 50 years. Probabilistic and univariate sensitivity analyses investigated DAA price reductions and variations in HCV treatment and disease care cost assumptions, using costs from different countries (Norway, United Kingdom, United States, France, Australia).
PWID attending community-based drug treatment centers for people with opioid dependence in Norway.
Incremental cost-effectiveness ratio (ICER) in terms of cost per QALY gained, compared against a conventional (€70 000/QALY) willingness-to-pay threshold for Norway and lower (€20 000/QALY) threshold common among high-income countries.
Integrated treatment resulted in an ICER of €13 300/QALY gained, with 99% and 71% probability of being cost-effective against conventional and lower willingness-to-pay thresholds, respectively. A 30% lower DAA price reduced the ICER to €6 900/QALY gained, with 91% probability of being cost-effective at the lower willingness-to-pay threshold. A 60% and 90% lower DAA price had 36% and >99% probability of being cost-saving, respectively. Sensitivity analyses suggest integrated treatment was cost-effective at the lower willingness-to-pay threshold (>60% probability) across different assumptions on HCV treatment and disease care costs with 30% DAA price reduction, and became cost-saving with 60%-90% price reductions.
Integrated hepatitis C virus treatment for people who inject drugs in community settings is likely cost-effective compared with standard-of-care referral pathways in Norway and may be cost-saving in settings with particular characteristics.
2017 年至 2019 年在挪威进行的 INTRO-HCV 随机对照试验发现，与标准护理医院治疗相比，用直接作用抗病毒药物（DAA）对丙型肝炎病毒（HCV）进行综合治疗可改善注射吸毒者（PWID）的治疗效果。我们评估了 INTRO-HCV 干预措施的成本效益。
这是一个 HCV 疾病进展和治疗的 Markov 健康状态转移模型，从卫生保健提供者的角度进行成本效益分析。主要的成本、效用和健康结果数据来自试验。成本和健康效益（质量调整生命年，QALY）在 50 年内进行跟踪。使用来自不同国家（挪威、英国、美国、法国、澳大利亚）的成本，通过 DAA 价格降低和 HCV 治疗和疾病护理成本假设的变化进行概率和单变量敏感性分析。
在挪威的社区毒品治疗中心接受阿片类药物依赖治疗的 PWID。
与挪威常规（70000 欧元/QALY）的意愿支付阈值和高收入国家常见的较低（20000 欧元/QALY）的意愿支付阈值相比，每获得一个 QALY 的增量成本效益比（ICER）。
综合治疗的 ICER 为 13300 欧元/QALY，对常规和较低的意愿支付阈值分别有 99%和 71%的概率具有成本效益。DAA 价格降低 30%可使 ICER 降低至 6900 欧元/QALY，对较低的意愿支付阈值具有 91%的概率具有成本效益。DAA 价格降低 60%和 90%，分别有 36%和>99%的概率具有成本节约性。敏感性分析表明，在 DAA 价格降低 30%的情况下，在不同的 HCV 治疗和疾病护理成本假设下，综合治疗在较低的意愿支付阈值（>60%的概率）具有成本效益，而在 60%-90%的价格降低时，综合治疗具有成本节约性。
与挪威的标准护理转诊途径相比，在社区环境中对注射吸毒者进行综合 HCV 治疗可能具有成本效益，在具有特定特征的环境中可能具有成本节约性。
