TY - JOUR
T1 - An intensive model of care for hepatitis C virus screening and treatment with direct-acting antivirals in people who inject drugs in Nairobi, Kenya
T2 - a model-based cost-effectiveness analysis
AU - Mafirakureva, Nyashadzaishe
AU - Stone, Jack
AU - Fraser, Hannah
AU - Nzomukunda, Yvonne
AU - Maina, Aron
AU - Thiong'o, Angela W.
AU - Kizito, Kibango Walter
AU - Mucara, Esther W.K.
AU - González Diaz, C. Inés
AU - Musyoki, Helgar
AU - Mundia, Bernard
AU - Cherutich, Peter
AU - Nyakowa, Mercy
AU - Lizcano, John
AU - Chhun, Nok
AU - Kurth, Ann
AU - Akiyama, Matthew J.
AU - Waruiru, Wanjiru
AU - Bhattacharjee, Parinita
AU - Cleland, Charles
AU - Donchuk, Dmytro
AU - Luhmann, Niklas
AU - Loarec, Anne
AU - Maman, David
AU - Walker, Josephine
AU - Vickerman, Peter
N1 - Funding Information:
Funding for this study was provided by Unitaid (grant SPHQ14-LOA-217) and Médecins Sans Frontières. P.V., H.F. and J.S. are supported by the National Institute for Health Research Health Protection Research Units (NIHR HPRUs) in Evaluation of Interventions and Behavioural Science at the University of Bristol in partnership with Public Health England (PHE). M.H., P.V. and H.F. also acknowledges support from the NIHR-funded EPIToPe project. P.V., H.F. and J.S. also acknowledge support from the US National Institute for Drug Abuse (NIDA grant number R01 AI147490, R01 DA033679, R01 DA037773, R21 DA046809 and R01 DA047952). P.V., J.S., B.M. and H.F. acknowledge support from Global Fund to Fight AIDS, Tuberculosis and Malaria, grant/award number: QPB-H-KANCO grant number 861. M.A., P.C., A.K. acknowledge support from grants (numbers R01DA032080 and R01DA032080-05S1, awarded to Principal Investigators A.K. and P.C.) from the National Institute on Drug Abuse.
Funding Information:
Funding for this study was provided by Unitaid (grant SPHQ14‐LOA‐217) and Médecins Sans Frontières. P.V., H.F. and J.S. are supported by the National Institute for Health Research Health Protection Research Units (NIHR HPRUs) in Evaluation of Interventions and Behavioural Science at the University of Bristol in partnership with Public Health England (PHE). M.H., P.V. and H.F. also acknowledges support from the NIHR‐funded EPIToPe project. P.V., H.F. and J.S. also acknowledge support from the US National Institute for Drug Abuse (NIDA grant number R01 AI147490, R01 DA033679, R01 DA037773, R21 DA046809 and R01 DA047952). P.V., J.S., B.M. and H.F. acknowledge support from Global Fund to Fight AIDS, Tuberculosis and Malaria, grant/award number: QPB‐H‐KANCO grant number 861. M.A., P.C., A.K. acknowledge support from grants (numbers R01DA032080 and R01DA032080‐05S1, awarded to Principal Investigators A.K. and P.C.) from the National Institute on Drug Abuse.
Publisher Copyright:
© 2021 Society for the Study of Addiction
PY - 2022/2
Y1 - 2022/2
N2 - 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.
AB - 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.
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U2 - 10.1111/add.15630
DO - 10.1111/add.15630
M3 - Article
C2 - 34184794
AN - SCOPUS:85111363712
SN - 0965-2140
VL - 117
SP - 411
EP - 424
JO - Addiction
JF - Addiction
IS - 2
ER -
