Historique
Article de Périodique
Evaluating the cost-effectiveness of existing needle and syringe programmes in preventing hepatitis C transmission in people who inject drugs (2019)
Auteur(s) :
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
Article en page(s) :
560-570
Refs biblio. :
57
Domaine :
Drogues illicites / Illicit drugs
Langue(s) :
Anglais
Discipline :
MAL (Maladies infectieuses / Infectious diseases)
Thésaurus géographique
ROYAUME-UNI
Thésaurus mots-clés
HEPATITE
;
COUT
;
EFFICACITE
;
PROGRAMME
;
ECHANGE DE SERINGUES
;
EVALUATION
;
USAGER
;
INJECTION
;
REDUCTION DES RISQUES ET DES DOMMAGES
;
ECONOMIE
;
MODELE STATISTIQUE
;
INFECTION
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.
- 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.
Résumé :
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.
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.
Affiliation :
Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK