|Titre :||Evaluating the cost-effectiveness of existing needle and syringe programmes in preventing hepatitis C transmission in people who inject drugs (2019)|
|Auteurs :||S. SWEENEY ; Z. WARD ; L. PLATT ; L. GUINNESS ; M. HICKMAN ; V. HOPE ; L. MAHER ; J. IVERSEN ; S. J. HUTCHINSON ; J. SMITH ; R. AYRES ; I. HAINEY ; P. VICKERMAN|
|Type de document :||Article : Périodique|
|Dans :||Addiction (Vol.114, n°3, March 2019)|
|Article en page(s) :||560-570|
|Note générale :||
Letters to the Editor:
- Monitoring emerging prescription-drug related harms: a comment on Cairns et al. Arunogiri S., Crossin R., Scott D., Lubman D.I., p. 571-572.
- Monitoring emerging prescription-drug related harms: a comment on Cairns et al. - in reply. Cairns R., Schaffer A.L., Ryan N., Pearson S.A., Buckley N.A., p. 572-573.
|Discipline :||MAL (Maladies infectieuses / Infectious diseases)|
Thésaurus TOXIBASEHEPATITE ; COUT ; EFFICACITE ; PROGRAMME ; ECHANGE DE SERINGUES ; EVALUATION ; USAGER ; INJECTION ; REDUCTION DES RISQUES ET DES DOMMAGES ; ECONOMIE ; MODELE STATISTIQUE ; INFECTION
AIM: To evaluate the cost-effectiveness of needle and syringe programmes (NSPs) compared with no NSPs on hepatitis C virus (HCV) transmission in the United Kingdom.
DESIGN: Cost-effectiveness analysis from a National Health Service (NHS)/health-provider perspective, utilizing a dynamic transmission model of HCV infection and disease progression, calibrated using city-specific surveillance and survey data, and primary data collection on NSP costs. The effectiveness of NSPs preventing HCV acquisition was based on empirical evidence.
SETTING AND PARTICIPANTS: UK settings with different chronic HCV prevalence among people who inject drugs (PWID): Dundee (26%), Walsall (18%) and Bristol (45%).
INTERVENTIONS: Current NSP provision is compared with a counterfactual scenario where NSPs are removed for 10 years and then returned to existing levels with effects collected for 40 years.
MEASUREMENTS: HCV infections and cost per quality-adjusted life year (QALY) gained through NSPs over 50 years.
FINDINGS: Compared with a willingness-to-pay threshold of £20 000 per QALY gained, NSPs were highly cost-effective over a time-horizon of 50 years and decreased the number of HCV incident infections. The mean incremental cost-effectiveness ratio was cost-saving in Dundee and Bristol, and £596 per QALY gained in Walsall, with 78, 46 and 40% of simulations being cost-saving in each city, respectively, with differences driven by coverage of NSP and HCV prevalence (lowest in Walsall). More than 90% of simulations were cost-effective at the willingness-to-pay threshold. Results were robust to sensitivity analyses, including varying the time-horizon, HCV treatment cost and numbers of HCV treatments per year.
CONCLUSIONS: Needle and syringe programmes are a highly effective low-cost intervention to reduce hepatitis C virus transmission, and in some settings they are cost-saving. Needle and syringe programmes are likely to remain cost-effective irrespective of changes in hepatitis C virus treatment cost and scale-up.
|Domaine :||Drogues illicites / Illicit drugs|
|Refs biblio. :||57|
|Affiliation :||Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK|