Cost-effectiveness of Hepatitis C virus self-testing in four settings

Abstract

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 uptake of HCV testing services. We compared cost per HCV viraemic diagnosis or cure for HCVST versus facility-based HCV testing services. We used a decision analysis model with a one-year time horizon to examine the key drivers of economic cost per diagnosis 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. Cost per HCV viraemic diagnosis without HCVST ranged from $35 2019 US dollars (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). 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.

Expanding hepatitis C virus test uptake using self-testing among men who have sex with men in China: two parallel randomized controlled trials

“…The cost of testing has been identified as an important barrier to HCV testing [ 13 ]. Whilst our study did not evaluate a long enough time horizon to capture the benefits of treatment, we provide evidence to support the findings of a modelling study by the WHO which explored the cost-effectiveness of HCV self-testing in China, Georgia, Vietnam and Kenya [ 42 ]. The cost-effectiveness of HCV self-testing is driven by its potential to increase the number of people tested so that they may be successfully treated to eliminate onward transmission; this ultimately reduces the HCV burden in a community.…”

Point-of-Care Testing for Hepatitis Viruses: A Growing Need

“…An additional advantage of these testing strategies is that POC anti-HCV and HCV RNA testing using fingerstick blood samples is generally well regarded by patients in terms of ease, acceptability, and preference compared with venipuncture [170,171]. A large evaluation of the cost-effectiveness of HCV self-testing in four different countries demonstrated that self-testing was not cost-efficient, but that it significantly increased the number of diagnosed and cured individuals [172]. However, cost differences were driven primarily by the treatment price and not the cost of diagnosis.…”