The cost-effectiveness of opioid agonist treatment in California's publicly-funded drug treatment facilities

Abstract Background HCV disproportionately affects marginalized communities such as homeless populations and people who inject drugs (PWID), posing a challenge to traditional health services. The HepFriend initiative in London is a model of care utilizing HCV outreach screening and peer support to link vulnerable individuals to HCV treatment in secondary care. Objectives To assess the cost-effectiveness of the HepFriend initiative from a healthcare provider perspective, compared with standard-of-care pathways (consisting of testing in primary care and other static locations, including drug treatment centres, and linkage to secondary care). Methods Cost-effectiveness analysis using a dynamic HCV transmission and disease progression model among PWID and those who have ceased injecting, including housing status and drug treatment service contact. The model was parameterized using London-specific surveillance and survey data, and primary intervention cost and effectiveness data (September 2015 to June 2018). Out of 461 individuals screened, 197 were identified as HCV RNA positive, 180 attended secondary care and 89 have commenced treatment to date. The incremental cost-effectiveness ratio (ICER) was determined using a 50 year time horizon. Results For a willingness-to-pay threshold of £20000 per QALY gained, the HepFriend initiative is cost-effective, with a mean ICER of £9408/QALY, and would become cost saving at 27% (£10525 per treatment) of the current drug list price. Results are robust to variations in intervention costs and model assumptions, and if treatment rates are doubled the intervention becomes more cost-effective (£8853/QALY). Conclusions New models of care that undertake active case-finding with enhanced peer support to improve testing and treatment uptake amongst marginalized and vulnerable groups could be highly cost-effective and possibly cost saving.

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Cost-Effectiveness of Cardiovascular Prevention Programs in Spain

International Journal of Technology Assessment in Health Care ◽

10.1017/s0266462300012289 ◽

1998 ◽

Vol 14 (2) ◽

pp. 320-330 ◽

Cited By ~ 39

Author(s):

Pedro Plans-rubió

Keyword(s):

Smoking Cessation ◽

Cost Effectiveness ◽

Drug Treatment ◽

Mild Hypertension ◽

Severe Hypertension ◽

Cardiovascular Prevention ◽

Dietary Treatment ◽

Prevention Programs ◽

Ranking List ◽

The Cost

AbstractIndividual programs for prevention of cardiovascular disease include dietary and drug treatment of hypercholesterolemia, hypertension treatment, and smoking cessation therapies. In this study, the cost-effectiveness of available cardiovascular prevention programs was assessed in Spain in terms of net cost per life-year gained (LYG). Cost-effectiveness ratios ranged from US $2,600 to $80,000 per LYG in men and from $4,500 to $230,000 per LYG in women. In men aged 40–59 years, the ranking of increasing cost-effectiveness was: smoking cessation ($2,608–3,738 per LYG); treatment of moderate and severe hypertension ($8,564–38,678 per LYG); treatment of mild hypertension ($11,906–59,840 per LYG); dietary treatment ($16,143–20,158 per LYG); and drug treatment of hypercholesterolemia ($33,850–81,010 per LYG). In women, the ranking list was: smoking cessation ($4,482–5,756 per LYG), treatment of moderate and severe hypertension ($9,585–57,983 per LYG), treatment of mild hypertension ($15,248–86,075 per LYG), dietary treatment ($57,175–62,154 per LYG); and drug treatment of hypercholesterolemia ($104,100–259,150 per LYG).

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