Cost Effectiveness of Screening Strategies for Early Identification of HIV and HCV Infection in Injection Drug Users

Cipriano, Lauren E.; Zaric, Gregory S.; Holodniy, Mark; Bendavid, Eran; Owens, Douglas K; Brandeau, Margaret L.

doi:10.1371/journal.pone.0045176

Cited by 55 publications

(88 citation statements)

References 149 publications

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“…Inmates co-infected with HIV or hepatitis B virus were not included because natural history of co-infection is complex, and although data on sofosbuvir’s effectiveness in this population are emerging, they are currently insufficient for accurate modeling of this group. Because the proportion of HCV-infected inmates co-infected with HIV is 14% (67), model-based analyses that incorporate co-infection should be undertaken when data availability permits (68). …”

Section: Discussionmentioning

confidence: 99%

Sofosbuvir-Based Treatment Regimens for Chronic, Genotype 1 Hepatitis C Virus Infection in U.S. Incarcerated Populations

Liu¹,

et al. 2014

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Background Prevalence of chronic hepatitis C virus (HCV) infection is high among incarcerated persons in the United States. New, short-duration, high-efficacy therapies may expand treatment eligibility in this population. Objective To assess the cost-effectiveness of sofosbuvir for HCV treatment in incarcerated populations. Design Markov model. Data Sources Published literature and expert opinion. Target Population Treatment-naive men with chronic, genotype 1 HCV monoinfection. Time Horizon Lifetime. Perspective Societal. Intervention No treatment, 2-drug therapy (pegylated interferon and ribavirin), or 3-drug therapy with either boceprevir or sofosbuvir. For inmates with short remaining sentences (<1.5 years), only no treatment or sofosbuvir 3-drug therapy were feasible; for those with long sentences (≥1.5 years; mean, 10 years), all strategies were considered. After release, eligible persons could receive sofosbuvir 3-drug therapy. Outcome Measures Discounted costs (in 2013 U.S. dollars), discounted quality-adjusted life-years (QALYs), and incremental cost-effectiveness ratios. Results of Base-Case Analysis The strategies yielded 13.12, 13.57, 14.43, and 15.18 QALYs, respectively, for persons with long sentences. Sofosbuvir produced the largest absolute reductions in decompensated cirrhosis (16%) and hepatocellular carcinoma (9%), resulting in 2.1 additional QALYs at an added cost exceeding $54 000 compared with no treatment. For persons with short sentences, sofosbuvir cost $25 700 per QALY gained compared with no treatment; for those with long sentences, it dominated other treatments, costing $28 800 per QALY gained compared with no treatment. Results of Sensitivity Analysis High reinfection rates in prison attenuated cost-effectiveness for persons with long sentences. Limitations Data on sofosbuvir’s long-term effectiveness and price are limited. The analysis did not consider women, Hispanic persons, or patients co-infected with HIV or hepatitis B virus. Conclusion Sofosbuvir-based treatment is cost-effective for incarcerated persons, but affordability is an important consideration. Primary Funding Source National Institutes of Health.

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Section: Discussionmentioning

confidence: 99%

Sofosbuvir-Based Treatment Regimens for Chronic, Genotype 1 Hepatitis C Virus Infection in U.S. Incarcerated Populations

Liu¹,

et al. 2014

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“…The cost-effectiveness of using both that POC Ab test and quantitative NAT (with prompt initiation of antiretroviral treatment in those identified with HIV infection) when compared with HIV-Ab testing alone has been reported for persons who inject drugs while undergoing HIV screening every 3-6 months [38]. The routine addition of quantitative viral load testing for all annual HIV tests in MSM, however, has been estimated to increase the cost of screening by more than $100 000 per quality-adjusted life year gained [39].…”

Section: Discussionmentioning

confidence: 99%

Costs per Diagnosis of Acute HIV Infection in Community-based Screening Strategies: A Comparative Analysis of Four Screening Algorithms

Hoenigl

Graff-Zivin

2015

Clinical Infectious Diseases

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Background. In nonhealthcare settings, widespread screening for acute human immunodeficiency virus (HIV) infection (AHI) is limited by cost and decision algorithms to better prioritize use of resources. Comparative cost analyses for available strategies are lacking.Methods. To determine cost-effectiveness of community-based testing strategies, we evaluated annual costs of 3 algorithms that detect AHI based on HIV nucleic acid amplification testing (EarlyTest algorithm) or on HIV p24 antigen (Ag) detection via Architect (Architect algorithm) or Determine (Determine algorithm) as well as 1 algorithm that relies on HIV antibody testing alone (Antibody algorithm). The cost model used data on men who have sex with men (MSM) undergoing community-based AHI screening in San Diego, California. Incremental cost-effectiveness ratios (ICERs) per diagnosis of AHI were calculated for programs with HIV prevalence rates between 0.1% and 2.9%.Results. Among MSM in San Diego, EarlyTest was cost-savings (ie, ICERs per AHI diagnosis less than $13.000) when compared with the 3 other algorithms. Cost analyses relative to regional HIV prevalence showed that EarlyTest was cost-effective (ie, ICERs less than $69.547) for similar populations of MSM with an HIV prevalence rate >0.4%; Architect was the second best alternative for HIV prevalence rates >0.6%.Conclusions. Identification of AHI by the dual EarlyTest screening algorithm is likely to be cost-effective not only among at-risk MSM in San Diego but also among similar populations of MSM with HIV prevalence rates >0.4%.

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“…Opioid agonist therapy includes methadone and buprenorphine maintenance therapies, which reduce injections by 55% (30) and decrease mortality but do not affect risky sexual behavior (31, 32). We assumed that 25% of PWID receive opioid agonist therapy and assessed varying levels of enrollment in sensitivity analysis ( Supplement , section 4.1.1) (4, 13, 31, 33, 34). The model is calibrated to U.S. HIV dynamics and hence reflects current levels of injection, including the effect of needle–syringe exchange programs.…”

Section: Methodsmentioning

confidence: 99%

Cost-Effectiveness of HIV Preexposure Prophylaxis for People Who Inject Drugs in the United States

et al. 2016

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Background The total population health benefits and costs of HIV preexposure prophylaxis (PrEP) for people who inject drugs (PWID) in the United States are unclear. Objective To evaluate the cost-effectiveness and optimal delivery conditions of PrEP for PWID. Design Empirically calibrated dynamic compartmental model. Data Sources Published literature and expert opinion. Target Population Adult U.S. PWID. Time Horizon 20 years and lifetime. Intervention PrEP alone, PrEP with frequent screening (PrEP+screen), and PrEP+screen with enhanced provision of antiretroviral therapy (ART) for individuals who become infected (PrEP+screen+ART). All scenarios are considered at 25% coverage. Outcome Measures Infections averted, deaths averted, change in HIV prevalence, discounted costs (in 2015 U.S. dollars), discounted quality-adjusted life-years (QALYs), and incremental cost-effectiveness ratios. Results of Base-Case Analysis PrEP+screen+ART dominates other strategies, averting 26 700 infections and reducing HIV prevalence among PWID by 14% compared with the status quo. Achieving these benefits costs $253 000 per QALY gained. At current drug prices, total expenditures for PrEP+screen+ART could be as high as $44 billion over 20 years. Results of Sensitivity Analysis Cost-effectiveness of the intervention is linear in the annual cost of PrEP and is dependent on PrEP drug adherence, individual transmission risks, and community HIV prevalence. Limitation Data on risk stratification and achievable PrEP efficacy levels for U.S. PWID are limited. Conclusion PrEP with frequent screening and prompt treatment for those who become infected can reduce HIV burden among PWID and provide health benefits for the entire U.S. population, but, at current drug prices, it remains an expensive intervention both in absolute terms and in cost per QALY gained. Primary Funding Source National Institute on Drug Abuse.

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Cost Effectiveness of Screening Strategies for Early Identification of HIV and HCV Infection in Injection Drug Users

Cited by 55 publications

References 149 publications

Sofosbuvir-Based Treatment Regimens for Chronic, Genotype 1 Hepatitis C Virus Infection in U.S. Incarcerated Populations

Sofosbuvir-Based Treatment Regimens for Chronic, Genotype 1 Hepatitis C Virus Infection in U.S. Incarcerated Populations

Costs per Diagnosis of Acute HIV Infection in Community-based Screening Strategies: A Comparative Analysis of Four Screening Algorithms

Cost-Effectiveness of HIV Preexposure Prophylaxis for People Who Inject Drugs in the United States

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