Modelling the force of infection for hepatitis B and hepatitis C in injecting drug users in England and Wales

Sutton, AJ; Edmunds, W. John; Hope, Vivian; Gill, O Nöel; Hickman, Matthew

doi:10.1186/1471-2334-6-93

Cited by 76 publications

(82 citation statements)

References 14 publications

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“…20,92 There are four injecting duration categories: < 3 years, ≥ 3 years to < 10 years, ≥ 10 years and ex-injecting drug users. All PWID enter the model as recently initiated PWID (< 3 years injecting category) at a constant rate θ, and then transition to non-recent PWID (at rate 1/3 year -1 ) and then to long-term PWID (at a rate of 1/7 year -1 from the non-recent PWID).…”

Section: Model Descriptionmentioning

confidence: 99%

Assessing the impact and cost-effectiveness of needle and syringe provision and opioid substitution therapy on hepatitis C transmission among people who inject drugs in the UK: an analysis of pooled data sets and economic modelling

et al. 2017

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Background There is limited evidence of the impact of needle and syringe programmes (NSPs) and opioid substitution therapy (OST) on hepatitis C virus (HCV) incidence among people who inject drugs (PWID), nor have there been any economic evaluations. Objective(s) To measure (1) the impact of NSP and OST, (2) changes in the extent of provision of both interventions, and (3) costs and cost-effectiveness of NSPs on HCV infection transmission. Design We conducted (1) a systematic review; (2) an analysis of existing data sets, including collating costs of NSPs; and (3) a dynamic deterministic model to estimate the impact of differing OST/NSP intervention coverage levels for reducing HCV infection prevalence, incidence and disease burden, and incremental cost-effectiveness ratios to measure the cost-effectiveness of current NSP provision versus no provision. Setting Cost-effectiveness analysis and impact modelling in three UK sites. The pooled analysis drew on data from the UK and Australia. The review was international. Participants PWID. Interventions NSP coverage (proportion of injections covered by clean needles) and OST. Outcome New cases of HCV infection. Results The review suggested that OST reduced the risk of HCV infection acquisition by 50% [rate ratio (RR) 0.50, 95% confidence interval (CI) 0.40 to 0.63]. Weaker evidence was found in areas of high (≥ 100%) NSP coverage (RR 0.77, 95% CI 0.38 to 1.54) internationally. There was moderate evidence for combined high coverage of NSPs and OST (RR 0.29, 95% CI 0.13 to 0.65). The pooled analysis showed that combined high coverage of NSPs and OST reduced the risk of HCV infection acquisition by 29–71% compared with those on minimal harm reduction (no OST, ≤ 100% NSP coverage). NSPs are likely to be cost-effective and are cost-saving in some settings. The impact modelling suggest that removing OST (current coverage 81%) and NSPs (coverage 54%) in one site would increase HCV infection incidence by 329% [95% credible interval (CrI) 110% to 953%] in 2031 and at least double (132% increase; 95% CrI 51% to 306%) the number of new infections over 15 years. Increasing NSP coverage to 80% has the largest impact in the site with the lowest current NSP coverage (35%), resulting in a 27% (95% CrI 7% to 43%) decrease in new infections and 41% (95% CrI 11% to 72%) decrease in incidence by 2031 compared with 2016. Addressing homelessness and reducing the harm associated with the injection of crack cocaine could avert approximately 60% of HCV infections over the next 15 years. Limitations Findings are limited by the misclassification of NSP coverage and the simplified intervention definition that fails to capture the integrated services that address other social and health needs as part of this. Conclusions There is moderate evidence of the effectiveness of OST and NSPs, especially in combination, on HCV infection acquisition risk. Policies to ensure that NSPs can be accessed alongside OST are needed. NSPs are cost-saving in some sites and cost-effective in others. NSPs and OST are likely to prevent considerable rates of HCV infection in the UK. Increasing NSP coverage will have most impact in settings with low coverage. Scaling up other interventions such as HCV infection treatment are needed to decrease epidemics to low levels in higher prevalence settings. Future work To understand the mechanisms through which NSPs and OST achieve their effect and the optimum contexts to support implementation. Funding The National Institute for Health Research Public Health Research programme.

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Section: Model Descriptionmentioning

confidence: 99%

Assessing the impact and cost-effectiveness of needle and syringe provision and opioid substitution therapy on hepatitis C transmission among people who inject drugs in the UK: an analysis of pooled data sets and economic modelling

et al. 2017

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“…The incidence of HBV infection among susceptible PWID in the United Kingdom was estimated at 2.16% per year using data from the national Unlinked Anonymous Monitoring Survey among current and past injectors and an approach similar to Sutton et al 23. Additional details are provided in the Supporting information.…”

Section: Methodsmentioning

confidence: 99%

An economic evaluation of contingency management for completion of hepatitis B vaccination in those on treatment for opiate dependence

et al. 2016

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AimsTo determine whether the provision of contingency management using financial incentives to improve hepatitis B vaccine completion in people who inject drugs entering community treatment represents a cost‐effective use of health‐care resources.DesignA probabilistic cost‐effectiveness analysis was conducted, using a decision‐tree to estimate the short‐term clinical and health‐care cost impact of the vaccination strategies, followed by a Markov process to evaluate the long‐term clinical consequences and costs associated with hepatitis B infection.Settings and participantsData on attendance to vaccination from a UK cluster randomized trial.InterventionTwo contingency management options were examined in the trial: fixed versus escalating schedule financial incentives.MeasurementLife‐time health‐care costs and quality‐adjusted life years discounted at 3.5% annually; incremental cost‐effectiveness ratios.FindingsThe resulting estimate for the incremental life‐time health‐care cost of the contingency management strategy versus usual care was £21.86 [95% confidence interval (CI) = –£12.20 to 39.86] per person offered the incentive. For 1000 people offered the incentive, the incremental reduction in numbers of hepatitis B infections avoided over their lifetime was estimated at 19 (95% CI = 8–30). The probabilistic incremental cost per quality adjusted life‐year gained of the contingency management programme was estimated to be £6738 (95% CI = £6297–7172), with an 89% probability of being considered cost‐effective at a threshold of £20 000 per quality‐adjusted life years gained (97.60% at £30 000).ConclusionsUsing financial incentives to increase hepatitis B vaccination completion in people who inject drugs could be a cost‐effective use of health‐care resources in the UK as long as the incidence remains above 1.2%.

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“…Previous studies have shown that younger IDUs with shorter injecting career lengths are at increased risk of blood-borne virus infection compared to more experienced IDUs [14]. Therefore it is of interest to consider whether a pulse or continuous vaccination strategy would be better at capturing younger IDUs for vaccination.…”

Section: Discussionmentioning

confidence: 99%

Modelling alternative strategies for delivering hepatitis B vaccine in prisons: the impact on the vaccination coverage of the injecting drug user population

Sutton

GAY²,

Edmunds³

et al. 2008

Epidemiol. Infect.

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SUMMARYSince 2001 hepatitis B vaccination has been offered to prisoners on reception into prisons in England and Wales. However, short campaigns of vaccinating the entire population of individual prisons have achieved high vaccination coverage for limited periods, suggesting that short campaigns may be a preferable way of vaccinating prisoners. A model is used that describes the flow of prisoners through prisons stratified by injecting status to compare a range of vaccination scenarios that describe vaccination on prison reception or via regular short campaigns. Model results suggest that vaccinating on prison reception can capture a greater proportion of the injecting drug user (IDU) population than the comparable campaign scenarios (63 % vs. 55 . 6% respectively). Vaccination on prison reception is also more efficient at capturing IDUs for vaccination than vaccination via a campaign, although vaccination via campaigns may have a role with some infections for overall control.

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Modelling the force of infection for hepatitis B and hepatitis C in injecting drug users in England and Wales

Cited by 76 publications

References 14 publications

Assessing the impact and cost-effectiveness of needle and syringe provision and opioid substitution therapy on hepatitis C transmission among people who inject drugs in the UK: an analysis of pooled data sets and economic modelling

Assessing the impact and cost-effectiveness of needle and syringe provision and opioid substitution therapy on hepatitis C transmission among people who inject drugs in the UK: an analysis of pooled data sets and economic modelling

An economic evaluation of contingency management for completion of hepatitis B vaccination in those on treatment for opiate dependence

Modelling alternative strategies for delivering hepatitis B vaccine in prisons: the impact on the vaccination coverage of the injecting drug user population

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