| Titre : | Effectiveness and cost-effectiveness of interventions targeting harm reduction and chronic hepatitis C cascade of care in people who inject drugs; the case of France (2018) |
| Auteurs : | A. COUSIEN ; V. C. TRAN ; S. DEUFFIC-BURBAN ; M. JAUFFRET-ROUSTIDE ; G. MABILEAU ; J. S. DHERSIN ; Y. YAZDANPANAH |
| Type de document : | Article : Périodique |
| Dans : | Journal of Viral Hepatitis (Vol.25, n°10, October 2018) |
| Article en page(s) : | 1197-1207 |
| Langues: | Anglais |
| Discipline : | MAL (Maladies infectieuses / Infectious diseases) |
| Mots-clés : |
Thésaurus géographique FRANCEThésaurus mots-clés HEPATITE ; INJECTION ; USAGER ; REDUCTION DES RISQUES ET DES DOMMAGES ; INTERVENTION ; EFFICACITE ; COUT ; MODELE STATISTIQUE |
| Résumé : | Direct-acting antivirals (DAAs) represent an opportunity to improve hepatitis C virus (HCV) care cascade. This, combined with improved harm reduction interventions may lead to HCV elimination especially in people who inject drugs (PWID). We assessed the effectiveness/cost-effectiveness of improvements in harm reduction and chronic hepatitis C (CHC) care cascade in PWID in France. We used a dynamic model of HCV transmission and CHC natural history and evaluated: improved needle/syringe programs-opioid substitution therapies, faster diagnosis/linkage to care, earlier treatment initiation, alone and in combination among active PWID (mean age=36). Outcomes were: life expectancy in discounted quality-adjusted life-years (QALYs); direct lifetime discounted costs; incremental cost-effectiveness ratio (ICER); number of infections/reinfections. Under the current practice, life expectancy was 15.846 QALYs, for a mean lifetime cost of euro20,762. Treatment initiation at F0 fibrosis stage alone was less effective and more costly than faster diagnosis/linkage to care combined with treatment initiation at F0, that increased life expectancy to 16.694 QALYs, decreased new infections by 37%, with a ICER=euro 5,300/QALY. Combining these interventions with harm reduction improvements was the most effective scenario (life expectancy =16.701 QALYs, 41% decrease in new infections) but was not cost-effective (ICER= euro 105,600/QALY); it became cost-effective with higher initial HCV incidence rates and lower harm reduction coverage than in our base-case scenario. This study illustrated the high effectiveness, and cost-effectiveness, of a faster diagnosis/linkage to care together with treatment from F0 with DAAs. This "Test and treat" strategy should play a central role both in improving the life expectancies of HCV-infected patients, and in reducing HCV transmission. This article is protected by copyright. All rights reserved. |
| Domaine : | Drogues illicites / Illicit drugs |
| Refs biblio. : | 52 |
| Affiliation : | IAME, UMR 1137, INSERM, Univ Paris Diderot, Sorbonne Paris Cite, Paris, France |
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