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Cost‐effectiveness of hepatitis C virus (HCV) elimination strategies among people who inject drugs (PWID) in Tijuana, Mexico.

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Title: Cost‐effectiveness of hepatitis C virus (HCV) elimination strategies among people who inject drugs (PWID) in Tijuana, Mexico.
Authors: Marquez, Lara K. (AUTHOR), Fleiz, Clara (AUTHOR), Burgos, Jose Luis (AUTHOR), Cepeda, Javier A. (AUTHOR), McIntosh, Craig (AUTHOR), Garfein, Richard S. (AUTHOR), Kiene, Susan M. (AUTHOR), Brodine, Stephanie (AUTHOR), Strathdee, Steffanie A. (AUTHOR), Martin, Natasha K. (AUTHOR)
Source: Addiction. Oct2021, Vol. 116 Issue 10, p2734-2745. 12p. 3 Charts, 3 Graphs.
Subjects: Hepatitis C prevention, Intravenous drug abusers, Disease progression, Substance abuse, Confidence intervals, Attitude (Psychology), Life expectancy, Medical personnel, Disease incidence, Antiviral agents, Harm reduction, Comparative studies, Cost effectiveness, Infectious disease transmission, Descriptive statistics, Parity (Obstetrics), Statistical models, People with disabilities
Geographic Terms: Tijuana (Baja California, Mexico), Mexico
Abstract: Background and Aims: In Latin America, Mexico was first to launch a hepatitis C virus (HCV) elimination strategy, where people who inject drugs (PWID) are a main risk group for transmission. In Tijuana, HCV seroprevalence among PWID is > 90%, with minimal harm reduction (HR). We evaluated cost‐effectiveness of strategies to achieve the incidence elimination target among PWID in Tijuana. Methods: Modeling study using a dynamic, cost‐effectiveness model of HCV transmission and progression among active and former PWID in Tijuana, to assess the cost‐effectiveness of incidence elimination strategies from a health‐care provider perspective. The model incorporated PWID transitions between HR stages (no HR, only opioid agonist therapy, only high coverage needle–syringe programs, both). Four strategies that could achieve the incidence target (80% reduction by 2030) were compared with the status quo (no intervention). The strategies incorporated the number of direct‐acting anti‐viral (DAA) treatments required with: (1) no HR scale‐up, (2) HR scale‐up from 2019 to 20% coverage among PWID, (3) HR to 40% coverage and (4) HR to 50% coverage. Costs (2019 US$) and health outcomes [disability‐adjusted life years (DALYs)] were discounted 3% per year. Mean incremental cost‐effectiveness ratios (ICER, $/DALY averted) were compared with one‐time per capita gross domestic product (GDP) ($9698 in 2019) and purchasing power parity‐adjusted per capita GDP ($4842–13 557) willingness‐to‐pay (WTP) thresholds. Results: DAAs alone were the least costly elimination strategy [$173 million, 95% confidence interval (CI) = 126–238 million], but accrued fewer health benefits compared with strategies with HR. DAAs + 50% HR coverage among PWID averted the most DALYs but cost $265 million, 95% CI = 210–335 million). The optimal strategy was DAAs + 50% HR (ICER $6743/DALY averted compared to DAAs only) under the one‐time per‐capita GDP WTP ($9698). Conclusions: A combination of high‐coverage harm reduction and hepatitis C virus treatment is the optimal cost‐effective strategy to achieve the HCV incidence elimination goal in Mexico. [ABSTRACT FROM AUTHOR]
Copyright of Addiction is the property of Wiley-Blackwell and its content may not be copied or emailed to multiple sites without the copyright holder's express written permission. Additionally, content may not be used with any artificial intelligence tools or machine learning technologies. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)
Database: Psychology and Behavioral Sciences Collection
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  Data: Cost‐effectiveness of hepatitis C virus (HCV) elimination strategies among people who inject drugs (PWID) in Tijuana, Mexico.
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  Data: <searchLink fieldCode="JN" term="%22Addiction%22">Addiction</searchLink>. Oct2021, Vol. 116 Issue 10, p2734-2745. 12p. 3 Charts, 3 Graphs.
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  Data: <searchLink fieldCode="DE" term="%22Hepatitis+C+prevention%22">Hepatitis C prevention</searchLink><br /><searchLink fieldCode="DE" term="%22Intravenous+drug+abusers%22">Intravenous drug abusers</searchLink><br /><searchLink fieldCode="DE" term="%22Disease+progression%22">Disease progression</searchLink><br /><searchLink fieldCode="DE" term="%22Substance+abuse%22">Substance abuse</searchLink><br /><searchLink fieldCode="DE" term="%22Confidence+intervals%22">Confidence intervals</searchLink><br /><searchLink fieldCode="DE" term="%22Attitude+%28Psychology%29%22">Attitude (Psychology)</searchLink><br /><searchLink fieldCode="DE" term="%22Life+expectancy%22">Life expectancy</searchLink><br /><searchLink fieldCode="DE" term="%22Medical+personnel%22">Medical personnel</searchLink><br /><searchLink fieldCode="DE" term="%22Disease+incidence%22">Disease incidence</searchLink><br /><searchLink fieldCode="DE" term="%22Antiviral+agents%22">Antiviral agents</searchLink><br /><searchLink fieldCode="DE" term="%22Harm+reduction%22">Harm reduction</searchLink><br /><searchLink fieldCode="DE" term="%22Comparative+studies%22">Comparative studies</searchLink><br /><searchLink fieldCode="DE" term="%22Cost+effectiveness%22">Cost effectiveness</searchLink><br /><searchLink fieldCode="DE" term="%22Infectious+disease+transmission%22">Infectious disease transmission</searchLink><br /><searchLink fieldCode="DE" term="%22Descriptive+statistics%22">Descriptive statistics</searchLink><br /><searchLink fieldCode="DE" term="%22Parity+%28Obstetrics%29%22">Parity (Obstetrics)</searchLink><br /><searchLink fieldCode="DE" term="%22Statistical+models%22">Statistical models</searchLink><br /><searchLink fieldCode="DE" term="%22People+with+disabilities%22">People with disabilities</searchLink>
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  Data: <searchLink fieldCode="DE" term="%22Tijuana+%28Baja+California%2C+Mexico%29%22">Tijuana (Baja California, Mexico)</searchLink><br /><searchLink fieldCode="DE" term="%22Mexico%22">Mexico</searchLink>
– Name: Abstract
  Label: Abstract
  Group: Ab
  Data: Background and Aims: In Latin America, Mexico was first to launch a hepatitis C virus (HCV) elimination strategy, where people who inject drugs (PWID) are a main risk group for transmission. In Tijuana, HCV seroprevalence among PWID is > 90%, with minimal harm reduction (HR). We evaluated cost‐effectiveness of strategies to achieve the incidence elimination target among PWID in Tijuana. Methods: Modeling study using a dynamic, cost‐effectiveness model of HCV transmission and progression among active and former PWID in Tijuana, to assess the cost‐effectiveness of incidence elimination strategies from a health‐care provider perspective. The model incorporated PWID transitions between HR stages (no HR, only opioid agonist therapy, only high coverage needle–syringe programs, both). Four strategies that could achieve the incidence target (80% reduction by 2030) were compared with the status quo (no intervention). The strategies incorporated the number of direct‐acting anti‐viral (DAA) treatments required with: (1) no HR scale‐up, (2) HR scale‐up from 2019 to 20% coverage among PWID, (3) HR to 40% coverage and (4) HR to 50% coverage. Costs (2019 US$) and health outcomes [disability‐adjusted life years (DALYs)] were discounted 3% per year. Mean incremental cost‐effectiveness ratios (ICER, $/DALY averted) were compared with one‐time per capita gross domestic product (GDP) ($9698 in 2019) and purchasing power parity‐adjusted per capita GDP ($4842–13 557) willingness‐to‐pay (WTP) thresholds. Results: DAAs alone were the least costly elimination strategy [$173 million, 95% confidence interval (CI) = 126–238 million], but accrued fewer health benefits compared with strategies with HR. DAAs + 50% HR coverage among PWID averted the most DALYs but cost $265 million, 95% CI = 210–335 million). The optimal strategy was DAAs + 50% HR (ICER $6743/DALY averted compared to DAAs only) under the one‐time per‐capita GDP WTP ($9698). Conclusions: A combination of high‐coverage harm reduction and hepatitis C virus treatment is the optimal cost‐effective strategy to achieve the HCV incidence elimination goal in Mexico. [ABSTRACT FROM AUTHOR]
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  Data: <i>Copyright of Addiction is the property of Wiley-Blackwell and its content may not be copied or emailed to multiple sites without the copyright holder's express written permission. Additionally, content may not be used with any artificial intelligence tools or machine learning technologies. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract.</i> (Copyright applies to all Abstracts.)
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      – Type: doi
        Value: 10.1111/add.15456
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        Text: English
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      – SubjectFull: Hepatitis C prevention
        Type: general
      – SubjectFull: Intravenous drug abusers
        Type: general
      – SubjectFull: Disease progression
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      – SubjectFull: Substance abuse
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      – SubjectFull: Confidence intervals
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      – SubjectFull: Tijuana (Baja California, Mexico)
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