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

26 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
Pages (from-to)129-143
Number of pages15
JournalAddiction
Volume110
Issue number1
DOIs
StatePublished - Jan 1 2015

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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

Cite this

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