Cost-effectiveness of hepatitis C virus (HCV) elimination strategies among people who inject drugs (PWID) in Tijuana, Mexico.

Autor: Marquez LK; University of California San Diego, La Jolla, CA, USA.; San Diego State University, San Diego, CA, USA., Fleiz C; National Institute of Psychiatry Ramon de la Fuente Muniz, Colonia, Huipulco, Tlalpan, Ciudad de Mexico, Mexico., Burgos JL; University of California San Diego, La Jolla, CA, USA., Cepeda JA; University of California San Diego, La Jolla, CA, USA., McIntosh C; University of California San Diego, La Jolla, CA, USA., Garfein RS; University of California San Diego, La Jolla, CA, USA., Kiene SM; San Diego State University, San Diego, CA, USA., Brodine S; San Diego State University, San Diego, CA, USA., Strathdee SA; University of California San Diego, La Jolla, CA, USA., Martin NK; University of California San Diego, La Jolla, CA, USA.; University of Bristol, Bristol, UK.
Jazyk: angličtina
Zdroj: Addiction (Abingdon, England) [Addiction] 2021 Oct; Vol. 116 (10), pp. 2734-2745. Date of Electronic Publication: 2021 Mar 22.
DOI: 10.1111/add.15456
Abstrakt: Background and Aims: In Latin America, Mexico was first to launch a hepatitis C virus (HCV) elimination strategy, where people who inject drugs (PWID) are a main risk group for transmission. In Tijuana, HCV seroprevalence among PWID is > 90%, with minimal harm reduction (HR). We evaluated cost-effectiveness of strategies to achieve the incidence elimination target among PWID in Tijuana.
Methods: Modeling study using a dynamic, cost-effectiveness model of HCV transmission and progression among active and former PWID in Tijuana, to assess the cost-effectiveness of incidence elimination strategies from a health-care provider perspective. The model incorporated PWID transitions between HR stages (no HR, only opioid agonist therapy, only high coverage needle-syringe programs, both). Four strategies that could achieve the incidence target (80% reduction by 2030) were compared with the status quo (no intervention). The strategies incorporated the number of direct-acting anti-viral (DAA) treatments required with: (1) no HR scale-up, (2) HR scale-up from 2019 to 20% coverage among PWID, (3) HR to 40% coverage and (4) HR to 50% coverage. Costs (2019 US$) and health outcomes [disability-adjusted life years (DALYs)] were discounted 3% per year. Mean incremental cost-effectiveness ratios (ICER, $/DALY averted) were compared with one-time per capita gross domestic product (GDP) ($9698 in 2019) and purchasing power parity-adjusted per capita GDP ($4842-13 557) willingness-to-pay (WTP) thresholds.
Results: DAAs alone were the least costly elimination strategy [$173 million, 95% confidence interval (CI) = 126-238 million], but accrued fewer health benefits compared with strategies with HR. DAAs + 50% HR coverage among PWID averted the most DALYs but cost $265 million, 95% CI = 210-335 million). The optimal strategy was DAAs + 50% HR (ICER $6743/DALY averted compared to DAAs only) under the one-time per-capita GDP WTP ($9698).
Conclusions: A combination of high-coverage harm reduction and hepatitis C virus treatment is the optimal cost-effective strategy to achieve the HCV incidence elimination goal in Mexico.
(© 2021 Society for the Study of Addiction.)
Databáze: MEDLINE
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