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

Abstract

Introduction: Globally, there are approximately 58 million people with chronic hepatitis C virus infection (HCV) but only 20% have been diagnosed. HCV self-testing (HCVST) could reach those who have never been tested and increase access and uptake of HCV testing services. We compared cost per HCV diagnosis or cure for HCVST versus facility-based HCV testing services. Methods: We used a decision analysis model with a one-year time horizon to examine the key drivers of economic cost per diagnosis (viraemic infection) or cure following the introduction of HCVST in China (men who have sex with men), Georgia (men 40-49 years), Viet Nam (people who inject drugs, PWID), and Kenya (PWID). HCV antibody (HCVAb) prevalence ranged from 1%-60% across settings. Model parameters in each setting were informed by HCV testing and treatment programmes, HIV self-testing programmes, and expert opinion. In the base case, we assume a reactive HCVST is followed by a facility-based rapid diagnostic test (RDT) and then nucleic acid testing (NAT). We assumed oral-fluid HCVST costs of $5.63/unit ($0.87-$21.43 for facility-based RDT), 62% increase in testing following HCVST introduction, 65% linkage following HCVST, and 10% replacement of facility-based testing with HCVST based on HIV studies. Parameters were varied in sensitivity analysis. Outcomes are reported in 2019 US dollars ($). Results: Cost per HCV viraemic diagnosis without HCVST ranged from $35 (Viet Nam) to $361 (Kenya). With HCVST, diagnosis increased resulting in incremental cost per diagnosis of $104 in Viet Nam, $163 in Georgia, $587 in Kenya, and $2,647 in China. Differences were driven by HCVAb prevalence. Switching to blood-based HCVST ($2.25/test), increasing uptake of HCVST and linkage to facility-based care and NAT testing, or proceeding directly to NAT testing following HCVST, reduced the cost per diagnosis. The baseline incremental cost per cure was lowest in Georgia ($1,418), similar in Viet Nam ($2,033), and Kenya ($2,566), and highest in China ($4,956). Conclusions: HCVST increased the number of people tested, diagnosed, and cured, but at higher cost. Introducing HCVST is more cost-effective in populations with high prevalence.

Cost of SARS-CoV-2 self-test distribution programmes by different modalities: a micro-costing study in five countries (Brazil, Georgia, Malaysia, Ethiopia and the Philippines)

“…8 Most of the empirical evidence on the cost of selftesting programmes originates from the human immunodeficiency virus (HIV) self-testing literature, 6 9 10 and more recently from hepatitis C virus (HCV) self-testing. 11 Studies have demonstrated the relative cost of different methods for rollout of HIV self-testing and found, broadly, that there are multiple ways of successfully distributing HIV self-testing, depending on the budget and desired outcome. For HIV self-testing, expansion of testing beyond primary healthcare clinics yielded a net increase in life years saved across all distribution models.…”

Use of indirect evidence from HIV self-testing to inform the WHO hepatitis C self-testing recommendation

“…A cost-effectiveness modelling study was conducted to identify drivers of cost of testing or HCV cure with introduction of HCVST across four countries 14. The cost-effectiveness model suggested that HCVST is likely to be costlier than standard testing but will reach more people for testing 14…”