Abstract
Background: We evaluated the cost-effectiveness of a hepatitis C (HCV) screening and active linkage to care intervention in US methadone maintenance treatment (MMT) patients using data from a randomized trial conducted in New York City and San Francisco. Methods: We used a decision analytic model to compare 1) no intervention; 2) HCV screening and education (control); and 3) HCV screening, education, and care coordination (active linkage intervention). We also explored an alternative strategy wherein HCV/HIV co-infected participants linked elsewhere. Trial data include population characteristics (67% male, mean age 48, 58% HCV infected) and linkage rates. Data from published sources include treatment efficacy and HCV re-infection risk. We projected quality-adjusted life years (QALYs) and lifetime medical costs using an established model of HCV (HEP-CE). Incremental cost-effectiveness ratios (ICERs) are in 2015 US$/QALY discounted 3% annually. Results: The control strategy resulted in a projected 35% linking to care within 6 months and 31% achieving sustained virologic response (SVR). The intervention resulted in 60% linking and 54% achieving SVR with an ICER of $24,600/QALY compared to no intervention from the healthcare sector perspective and was a more efficient use of resources than the control strategy. The intervention had an ICER of $76,500/QALY compared to the alternative strategy. From a societal perspective, the intervention had a net monetary benefit of $511,000–$975,600. Conclusions: HCV care coordination interventions that include screening, education and active linkage to care in MMT settings are likely cost-effective at a conventional $100,000/QALY threshold for both HCV mono-infected and HIV co-infected patients.
| Original language | English (US) |
|---|---|
| Pages (from-to) | 411-420 |
| Number of pages | 10 |
| Journal | Drug and Alcohol Dependence |
| Volume | 185 |
| DOIs | |
| State | Published - Apr 1 2018 |
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Keywords
- Cost-effectiveness
- Hepatitis C
- Methadone maintenance therapy
ASJC Scopus subject areas
- Toxicology
- Pharmacology
- Psychiatry and Mental health
- Pharmacology (medical)
Cite this
Cost-effectiveness of hepatitis C screening and treatment linkage intervention in US methadone maintenance treatment programs. / Schackman, Bruce R.; Gutkind, Sarah; Morgan, Jake R.; Leff, Jared A.; Behrends, Czarina N.; Delucchi, Kevin L.; Mcknight, Courtney; Perlman, David C.; Masson, Carmen L.; Linas, Benjamin P.
In: Drug and Alcohol Dependence, Vol. 185, 01.04.2018, p. 411-420.Research output: Contribution to journal › Article
}
TY - JOUR
T1 - Cost-effectiveness of hepatitis C screening and treatment linkage intervention in US methadone maintenance treatment programs
AU - Schackman, Bruce R.
AU - Gutkind, Sarah
AU - Morgan, Jake R.
AU - Leff, Jared A.
AU - Behrends, Czarina N.
AU - Delucchi, Kevin L.
AU - Mcknight, Courtney
AU - Perlman, David C.
AU - Masson, Carmen L.
AU - Linas, Benjamin P.
PY - 2018/4/1
Y1 - 2018/4/1
N2 - Background: We evaluated the cost-effectiveness of a hepatitis C (HCV) screening and active linkage to care intervention in US methadone maintenance treatment (MMT) patients using data from a randomized trial conducted in New York City and San Francisco. Methods: We used a decision analytic model to compare 1) no intervention; 2) HCV screening and education (control); and 3) HCV screening, education, and care coordination (active linkage intervention). We also explored an alternative strategy wherein HCV/HIV co-infected participants linked elsewhere. Trial data include population characteristics (67% male, mean age 48, 58% HCV infected) and linkage rates. Data from published sources include treatment efficacy and HCV re-infection risk. We projected quality-adjusted life years (QALYs) and lifetime medical costs using an established model of HCV (HEP-CE). Incremental cost-effectiveness ratios (ICERs) are in 2015 US$/QALY discounted 3% annually. Results: The control strategy resulted in a projected 35% linking to care within 6 months and 31% achieving sustained virologic response (SVR). The intervention resulted in 60% linking and 54% achieving SVR with an ICER of $24,600/QALY compared to no intervention from the healthcare sector perspective and was a more efficient use of resources than the control strategy. The intervention had an ICER of $76,500/QALY compared to the alternative strategy. From a societal perspective, the intervention had a net monetary benefit of $511,000–$975,600. Conclusions: HCV care coordination interventions that include screening, education and active linkage to care in MMT settings are likely cost-effective at a conventional $100,000/QALY threshold for both HCV mono-infected and HIV co-infected patients.
AB - Background: We evaluated the cost-effectiveness of a hepatitis C (HCV) screening and active linkage to care intervention in US methadone maintenance treatment (MMT) patients using data from a randomized trial conducted in New York City and San Francisco. Methods: We used a decision analytic model to compare 1) no intervention; 2) HCV screening and education (control); and 3) HCV screening, education, and care coordination (active linkage intervention). We also explored an alternative strategy wherein HCV/HIV co-infected participants linked elsewhere. Trial data include population characteristics (67% male, mean age 48, 58% HCV infected) and linkage rates. Data from published sources include treatment efficacy and HCV re-infection risk. We projected quality-adjusted life years (QALYs) and lifetime medical costs using an established model of HCV (HEP-CE). Incremental cost-effectiveness ratios (ICERs) are in 2015 US$/QALY discounted 3% annually. Results: The control strategy resulted in a projected 35% linking to care within 6 months and 31% achieving sustained virologic response (SVR). The intervention resulted in 60% linking and 54% achieving SVR with an ICER of $24,600/QALY compared to no intervention from the healthcare sector perspective and was a more efficient use of resources than the control strategy. The intervention had an ICER of $76,500/QALY compared to the alternative strategy. From a societal perspective, the intervention had a net monetary benefit of $511,000–$975,600. Conclusions: HCV care coordination interventions that include screening, education and active linkage to care in MMT settings are likely cost-effective at a conventional $100,000/QALY threshold for both HCV mono-infected and HIV co-infected patients.
KW - Cost-effectiveness
KW - Hepatitis C
KW - Methadone maintenance therapy
UR - http://www.scopus.com/inward/record.url?scp=85044965353&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85044965353&partnerID=8YFLogxK
U2 - 10.1016/j.drugalcdep.2017.11.031
DO - 10.1016/j.drugalcdep.2017.11.031
M3 - Article
C2 - 29477574
AN - SCOPUS:85044965353
VL - 185
SP - 411
EP - 420
JO - Drug and Alcohol Dependence
JF - Drug and Alcohol Dependence
SN - 0376-8716
ER -