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Abstract Details
Economic Impact of Universal Hepatitis C Virus Testing for Middle-Aged Adults Who Inject Drugs
Am J Prev Med. 2022 Oct 15;S0749-3797(22)00448-2. doi: 10.1016/j.amepre.2022.08.016.Online ahead of print.
1Department of Pharmaceutical Outcomes & Policy, University of Florida College of Pharmacy, Gainesville, Florida.
2Department of Pharmaceutical Outcomes & Policy, University of Florida College of Pharmacy, Gainesville, Florida; Center for Drug Evaluation and Safety (CoDES), University of Florida College of Pharmacy, Gainesville, Florida.
3Department of Biostatistics, University of Florida College of Public Health and Health Professions & College of Medicine, Gainesville, Florida.
4Department of Pharmaceutical Outcomes & Policy, University of Florida College of Pharmacy, Gainesville, Florida; Center for Drug Evaluation and Safety (CoDES), University of Florida College of Pharmacy, Gainesville, Florida. Electronic address: hpark@cop.ufl.edu.
Abstract
Introduction: The objective of this study was to estimate the economic impact of providing universal hepatitis C virus testing in commercially insured middle-aged persons who inject drugs in the U.S.
Methods: This study developed a dynamic 10-year economic model to project the clinical and economic outcomes associated with hepatitis C virus testing among middle-aged adult persons who inject drugs, from a payer's perspective. Costs related to hepatitis C virus testing, direct-acting antiviral, and liver-related outcomes between the (1) current hepatitis C virus testing rate (i.e., 8%) and (2) universal hepatitis C virus testing rate (i.e., 100%) were compared. Among patients testing positive, 21% of those without cirrhosis and 48% of those with cirrhosis were assumed to initiate direct-acting antivirals. Sensitivity analyses were performed to identify variables (e.g., direct-acting antiviral drug costs, hepatitis C virus testing costs, direct-acting antiviral treatment rate) influencing this study's conclusion.
Results: The model predicts that during the 10-year period, universal hepatitis C virus testing will cost an additional $242 per person who injects drugs to the payers' healthcare budgets compared with the current scenario. Sensitivity analyses showed values ranging from $1,656 additional costs to $1,085 cost savings across all varied parameters and scenarios. A total of 80% of the current direct-acting antiviral costs indicated that cost savings will be $383 per person who injects drugs.
Conclusions: Universal hepatitis C virus testing among persons who inject drugs would not achieve cost savings within 10 years, with the cost of direct-acting antivirals contributing the most to the spending. To promote universal hepatitis C virus testing among persons who inject drugs, decreasing direct-acting antiviral costs and sustainable funding streams for hepatitis C virus testing should be considered.