Cost-effectiveness of rapid hepatitis C virus (HCV) testing and simultaneous rapid HCV and HIV testing in substance abuse treatment programs

Bruce R. Schackman, Jared A. Leff, Devra M. Barter, Madeline A. Dilorenzo, Daniel J. Feaster, Lisa R. Metsch, Kenneth A. Freedberg, Benjamin P. Linas

Research output: Contribution to journalArticle

27 Scopus citations

Abstract

Aims: To evaluate the cost-effectiveness of rapid hepatitis C virus (HCV) and simultaneous HCV/HIV antibody testing in substance abuse treatment programs. Design: We used a decision analytic model to compare the cost-effectiveness of no HCV testing referral or offer, off-site HCV testing referral, on-site rapid HCV testing offer and on-site rapid HCV and HIV testing offer. Base case inputs included 11% undetected chronic HCV, 0.4% undetected HIV, 35% HCV co-infection among HIV-infected, 53% linked to HCV care after testing antibody-positive and 67% linked to HIV care. Disease outcomes were estimated from established computer simulation models of HCV [Hepatitis C Cost-Effectiveness (HEP-CE)] and HIV [Cost-Effectiveness of Preventing AIDS Complications (CEPAC)]. Setting and participants: Data on test acceptance and costs were from a national randomized trial of HIV testing strategies conducted at 12 substance abuse treatment programs in the United States. Measurements: Lifetime costs (2011 US$) and quality-adjusted life years (QALYs) discounted at 3% annually; incremental cost-effectiveness ratios (ICERs). Findings: On-site rapid HCV testing had an ICER of $18300/QALY compared with no testing, and was more efficient than (dominated) off-site HCV testing referral. On-site rapid HCV and HIV testing had an ICER of $64500/QALY compared with on-site rapid HCV testing alone. In one- and two-way sensitivity analyses, the ICER of on-site rapid HCV and HIV testing remained <$100000/QALY, except when undetected HIV prevalence was <0.1% or when we assumed frequent HIV testing elsewhere. The ICER remained <$100000/QALY in 91% of probabilistic sensitivity analyses. Conclusions: On-site rapid hepatitis C virus and HIV testing in substance abuse treatment programs is cost-effective at a <$100000/quality-adjusted life year threshold.

Original languageEnglish (US)
Pages (from-to)129-143
Number of pages15
JournalAddiction
Volume110
Issue number1
DOIs
StatePublished - Jan 1 2015

Keywords

  • Computer simulation model
  • Cost-effectiveness
  • Economic evaluation
  • Hepatitis C testing
  • Rapid HIV testing
  • Substance abuse treatment

ASJC Scopus subject areas

  • Medicine (miscellaneous)
  • Psychiatry and Mental health

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    Schackman, B. R., Leff, J. A., Barter, D. M., Dilorenzo, M. A., Feaster, D. J., Metsch, L. R., Freedberg, K. A., & Linas, B. P. (2015). Cost-effectiveness of rapid hepatitis C virus (HCV) testing and simultaneous rapid HCV and HIV testing in substance abuse treatment programs. Addiction, 110(1), 129-143. https://doi.org/10.1111/add.12754