An intensive model of care for hepatitis C virus screening and treatment with direct‐acting antivirals in people who inject drugs in Nairobi, Kenya: a model‐based cost‐effectiveness analysis

Background and aims 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 amon...

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Published in:	Addiction (Abingdon, England) Vol. 117; no. 2; pp. 411 - 424
Main Authors:	Mafirakureva, Nyashadzaishe, Stone, Jack, Fraser, Hannah, Nzomukunda, Yvonne, Maina, Aron, Thiong'o, Angela W., Kizito, Kibango Walter, Mucara, Esther W. K., González Diaz, C. Inés, Musyoki, Helgar, Mundia, Bernard, Cherutich, Peter, Nyakowa, Mercy, Lizcano, John, Chhun, Nok, Kurth, Ann, Akiyama, Matthew J., Waruiru, Wanjiru, Bhattacharjee, Parinita, Cleland, Charles, Donchuk, Dmytro, Luhmann, Niklas, Loarec, Anne, Maman, David, Walker, Josephine, Vickerman, Peter
Format:	Journal Article
Language:	English
Published:	England Blackwell Publishing Ltd 01-02-2022
Subjects:	Antiviral agents Antiviral Agents - therapeutic use Antiviral drugs Chronic hepatitis C Cost analysis Cost-Benefit Analysis Costs cost‐effectiveness Directly observed therapy direct‐acting antiviral treatment Disability Disability-Adjusted Life Years Disease transmission Drug prices Drug use Drug Users Harm reduction Health care expenditures Hepacivirus Hepatitis Hepatitis C Hepatitis C - drug therapy Hepatitis C, Chronic - drug therapy HIV Human immunodeficiency virus Humans Intervention Kenya low‐income setting Medical personnel Medical screening Money people who inject drugs Prices Sensitivity analysis Substance Abuse, Intravenous - drug therapy Viruses Kenya Nairobi Kenya direct-acting antiviral treatment cost-effectiveness Chronic hepatitis C Kenya people who inject drugs low-income setting
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Summary:	Background and aims 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. Design 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. Setting Nairobi, Kenya. Population PWID. Measurements Treatment costs, incremental cost‐effectiveness ratio (cost per disability‐adjusted life year averted). Findings 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. Conclusions 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.
Bibliography:	† Joint last authors. Please see complete list of author affiliations at the end of the paper. Nyashadzaishe Mafirakureva: Conceptualization; data curation; formal analysis; investigation; methodology; project administration; software; visualization. Jack Stone: Formal analysis; methodology; software. Hannah Fraser: Methodology; software. Yvonne Nzomukunda: Data curation; investigation; project administration; resources. Aron Maina: Data curation; investigation. Angela Thiong’o: Data curation; investigation. Kibango Kizito: Data curation; project administration. Esther Mucara: Data curation; investigation. C. Inés González Diaz: Conceptualization; data curation; project administration. Helgar Musyoki: Conceptualization; supervision. Benard Mundia: Funding acquisition; investigation. Peter Cherutich: Funding acquisition. Mercy Nyakowa: Data curation; investigation. John Lizcano: Data curation; investigation. Nok Chhun: Data curation; investigation. Ann Kurth: Funding acquisition. Matthew Akiyama: Funding acquisition. Parinita Bhattacharjee: Conceptualization; supervision. Dmytro Donchuk: Conceptualization. Niklas Luhmann: Conceptualization. Anne Loarec: Conceptualization; funding acquisition; project administration. David Maman: Conceptualization; supervision. Josephine Walker: Conceptualization; data curation; formal analysis; investigation; methodology; project administration; software. Peter Vickerman: Conceptualization; funding acquisition; methodology; supervision. Author contributions
ISSN:	0965-2140 1360-0443
DOI:	10.1111/add.15630