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

Abstract

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.

Cost and cost-effectiveness of Hepatitis C virus self-testing in four settings: an economic evaluation

“…In the early days of HIVST research, modelling studies predicted that HIVST would be cost-effective [12] and subsequent studies confirmed this. Cost-effectiveness studies of HIVST in LMIC also found the introduction of self-testing led to increased diagnosis and linkage to care, but with an additional cost to identify each case [17,26]. The first HCVST real world implementation studies are currently underway, piloting different models of HCVST distribution in Malaysia and Pakistan[14, 15].…”

“…These additional costs need to be minimised through ensuring that test costs are kept low and linkage to care rates are high. [24,26,30]) and have sensitivity and specificity of 100% as they are the gold standard against which the RDTs are compared.…”

Modelling the impact of HIV and hepatitis C virus prevention and treatment interventions among people who inject drugs in Kenya

“…In addition, HCV testing needs expanding to allow HCV treatment scale-up; only 22% of PWID in 2015 reported being tested for HCV in last 3 months compared with 74% for HIV [ 7 ]. This testing could occur when HIV testing occurs through NSP or OAT clinics as demonstrated by two pilot HCV screening and treatment interventions in Kenya [ 16 , 42 ].…”

“…Following HCV infection, some PWID spontaneously clear infection (differs by HIV infection), with the remainder progressing to chronic infection. Chronically infected PWID can receive HCV treatment, with most (90.1% [ 16 ]) achieving a sustained virologic response (SVR). Those not achieving SVR return to the chronically infected compartment and are eligible for re-treatment.…”

“…ART has scaled-up in Kenya, with 86% of PWH on ART in 2020 [ 15 ] and 64–68% among PWID in 2015 [ 4 ]. Although access to HCV diagnosis and treatment has been negligible in Kenya, recent pilot programmes among PWID have demonstrated the feasibility of such strategies [ 16 ]. The Kenyan government has recently secured direct-acting antiviral (DAA) treatments for 1000 people, with their national HCV guidelines recognizing PWID as a priority population [ 17 ].…”