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Wolfson-Stofko B, Hirode G, Vanderhoff A, Karkada J, Capraru C, Biondi MJ, Hansen B, Shah H, Janssen HLA, Feld JJ. Real-world hepatitis C prevalence and treatment uptake at opioid agonist therapy clinics in Ontario, Canada. J Viral Hepat 2024; 31:240-247. [PMID: 38385850 DOI: 10.1111/jvh.13931] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2023] [Revised: 02/02/2024] [Accepted: 02/15/2024] [Indexed: 02/23/2024]
Abstract
Widespread screening for hepatitis C virus (HCV) is necessary for Canada to meet its HCV elimination goals by 2030. People who currently or previously injected drugs are at high risk for HCV. Opioid agonist therapy (OAT, such as methadone and buprenorphine) has been shown to help stabilize the lives of people who are opioid-dependent. The distribution of OAT in North America typically requires daily, weekly, or monthly clinic visits and presents an opportunity for engagement, screening and treatment for those at high-risk of HCV. In this study, HCV screening was conducted by staff at OAT clinics in Ontario from 2016 to 2020 and those with chronic infections were treated on-site with direct-acting antivirals. Point-of-care or dried blood spot (DBS) testing was used for antibodies, DBS or serum for HCV RNA and serum for HCV RNA at SVR12 (sustained virological response). Clinics screened 1954 people (mean age 40 years ±12, 63% male). Forty-five percent were antibody positive, of whom 64% were HCV RNA+. Eighty percent of those RNA+ set an appointment in which 99% attended. Ninety-six percent started treatment with 87% completing treatment. Sixty-eight percent of people who completed treatment submitted a sample for SVR12 testing of which 97% achieved a virological cure. Results suggest that HCV screening and treatment at OAT clinics is feasible, effective and warrants expansion. Data suggest strong treatment adherence due to high rates of SVR12 comparable with other OAT-based HCV treatment programs. The lack of SVR12 sampling could be addressed by either on-site phlebotomy or incentivizing SVR12 sampling.
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Affiliation(s)
- B Wolfson-Stofko
- Viral Hepatitis Care Network (VIRCAN), Toronto Centre for Liver Disease, University Health Network, Toronto, Ontario, Canada
- Center for Drug Use and HIV/HCV Research (CDUHR), College of Global Public Health, New York University, New York, New York, USA
| | - G Hirode
- Viral Hepatitis Care Network (VIRCAN), Toronto Centre for Liver Disease, University Health Network, Toronto, Ontario, Canada
| | - A Vanderhoff
- Viral Hepatitis Care Network (VIRCAN), Toronto Centre for Liver Disease, University Health Network, Toronto, Ontario, Canada
| | - J Karkada
- Viral Hepatitis Care Network (VIRCAN), Toronto Centre for Liver Disease, University Health Network, Toronto, Ontario, Canada
| | - C Capraru
- Viral Hepatitis Care Network (VIRCAN), Toronto Centre for Liver Disease, University Health Network, Toronto, Ontario, Canada
| | - M J Biondi
- Viral Hepatitis Care Network (VIRCAN), Toronto Centre for Liver Disease, University Health Network, Toronto, Ontario, Canada
- School of Nursing, York University, Toronto, Ontario, Canada
| | - B Hansen
- Viral Hepatitis Care Network (VIRCAN), Toronto Centre for Liver Disease, University Health Network, Toronto, Ontario, Canada
- Division of Gastroenterology & Hepatology, Erasmus Medical Center, Rotterdam, The Netherlands
- Department of Epidemiology, Biostatistics, Erasmus MC University Medical Center, Rotterdam, the Netherlands
- Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - H Shah
- Viral Hepatitis Care Network (VIRCAN), Toronto Centre for Liver Disease, University Health Network, Toronto, Ontario, Canada
| | - H L A Janssen
- Viral Hepatitis Care Network (VIRCAN), Toronto Centre for Liver Disease, University Health Network, Toronto, Ontario, Canada
- Division of Gastroenterology & Hepatology, Erasmus Medical Center, Rotterdam, The Netherlands
| | - J J Feld
- Viral Hepatitis Care Network (VIRCAN), Toronto Centre for Liver Disease, University Health Network, Toronto, Ontario, Canada
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Lim AG, Aas CF, Çağlar ES, Vold JH, Fadnes LT, Vickerman P, Johansson KA. Cost-effectiveness of integrated treatment for hepatitis C virus (HCV) among people who inject drugs in Norway: An economic evaluation of the INTRO-HCV trial. Addiction 2023; 118:2424-2439. [PMID: 37515462 PMCID: PMC10952903 DOI: 10.1111/add.16305] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2022] [Accepted: 06/26/2023] [Indexed: 07/30/2023]
Abstract
BACKGROUND AND AIMS The INTRO-HCV randomized controlled trial conducted in Norway over 2017-2019 found that integrated treatment, compared with standard-of-care hospital treatment, for hepatitis C virus (HCV) with direct-acting antivirals (DAAs) improved treatment outcomes among people who inject drugs (PWID). We evaluated cost-effectiveness of the INTRO-HCV intervention. DESIGN A Markov health state transition model of HCV disease progression and treatment with cost-effectiveness analysis from the health-provider perspective. Primary cost, utility, and health outcome data were derived from the trial. Costs and health benefits (quality-adjusted life-years, QALYs) were tracked over 50 years. Probabilistic and univariate sensitivity analyses investigated DAA price reductions and variations in HCV treatment and disease care cost assumptions, using costs from different countries (Norway, United Kingdom, United States, France, Australia). SETTING AND PARTICIPANTS PWID attending community-based drug treatment centers for people with opioid dependence in Norway. MEASUREMENTS Incremental cost-effectiveness ratio (ICER) in terms of cost per QALY gained, compared against a conventional (€70 000/QALY) willingness-to-pay threshold for Norway and lower (€20 000/QALY) threshold common among high-income countries. FINDINGS Integrated treatment resulted in an ICER of €13 300/QALY gained, with 99% and 71% probability of being cost-effective against conventional and lower willingness-to-pay thresholds, respectively. A 30% lower DAA price reduced the ICER to €6 900/QALY gained, with 91% probability of being cost-effective at the lower willingness-to-pay threshold. A 60% and 90% lower DAA price had 36% and >99% probability of being cost-saving, respectively. Sensitivity analyses suggest integrated treatment was cost-effective at the lower willingness-to-pay threshold (>60% probability) across different assumptions on HCV treatment and disease care costs with 30% DAA price reduction, and became cost-saving with 60%-90% price reductions. CONCLUSIONS Integrated hepatitis C virus treatment for people who inject drugs in community settings is likely cost-effective compared with standard-of-care referral pathways in Norway and may be cost-saving in settings with particular characteristics.
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Affiliation(s)
- Aaron Guanliang Lim
- Population Health Sciences, Bristol Medical SchoolUniversity of BristolBristolUK
| | - Christer Frode Aas
- Bergen Addiction Research, Department of Addiction MedicineHaukeland University HospitalBergenNorway
- Department of Global Public Health and Primary CareUniversity of BergenBergenNorway
- Division of PsychiatryHaukeland University HospitalBergenNorway
| | - Ege Su Çağlar
- Bergen Addiction Research, Department of Addiction MedicineHaukeland University HospitalBergenNorway
- Department of Global Public Health and Primary CareUniversity of BergenBergenNorway
| | - Jørn Henrik Vold
- Bergen Addiction Research, Department of Addiction MedicineHaukeland University HospitalBergenNorway
- Department of Global Public Health and Primary CareUniversity of BergenBergenNorway
- Division of PsychiatryHaukeland University HospitalBergenNorway
| | - Lars Thore Fadnes
- Bergen Addiction Research, Department of Addiction MedicineHaukeland University HospitalBergenNorway
- Department of Global Public Health and Primary CareUniversity of BergenBergenNorway
| | - Peter Vickerman
- Population Health Sciences, Bristol Medical SchoolUniversity of BristolBristolUK
| | - Kjell Arne Johansson
- Bergen Addiction Research, Department of Addiction MedicineHaukeland University HospitalBergenNorway
- Department of Global Public Health and Primary CareUniversity of BergenBergenNorway
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Desai A, O'Neal L, Reinis K, Chang P, Brown C, Stefanowicz M, Kuang A, Agrawal D, Bhavnani D, Mercer T. Development, implementation, and feasibility of site-specific hepatitis C virus treatment workflows for treating vulnerable, high-risk populations: protocol of the Erase Hep C study - a prospective single-arm intervention trial. Pilot Feasibility Stud 2023; 9:78. [PMID: 37158965 PMCID: PMC10165844 DOI: 10.1186/s40814-023-01311-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Accepted: 04/26/2023] [Indexed: 05/10/2023] Open
Abstract
BACKGROUND Hepatitis C virus (HCV) is the leading indication for liver transplantation and liver-related mortality. The development of direct-acting antivirals (DAA) and a simplified treatment algorithm with a > 97% cure rate should make global elimination of HCV an achievable goal. Yet, vulnerable populations with high rates of HCV still have limited access to treatment. By designing locally contextualized site-specific HCV treatment workflows, we aim to cure HCV in vulnerable, high-risk populations, including people experiencing homelessness (PEH) and people who inject drugs (PWID), in Austin, TX, USA. METHODS Our implementation science study will utilize a qualitative and design thinking approach to characterize patient and systemic barriers and facilitators to HCV treatment in vulnerable, high-risk populations seeking care across seven diverse primary care clinics serving PEHs and PWIDs. Qualitative interviews guided by the Practical, Robust Implementation and Sustainability Model (PRISM) framework will identify barriers and facilitators by leveraging knowledge and experience from both clinic staff and patients. Data synthesized using thematic analysis and design thinking will feed into workshops with clinic stakeholders for idea generation to design site-specific HCV treatment workflows. Providers will be trained on the use of a simplified HCV treatment algorithm with DAAs and clinic staff on the new site-specific HCV treatment workflows. These workflows will be implemented by the seven diverse primary care clinics serving vulnerable, high-risk populations. Implementation and clinical outcomes will be measured using data collected through interviews with staff as well as through medical chart review. DISCUSSION Our study provides a model of how to contextualize and implement site-specific HCV treatment workflows targeting vulnerable, high-risk populations in other geographic locations. This model can be adopted for future implementation research programs aiming to develop and implement site-specific treatment workflows for vulnerable, high-risk populations and in primary care clinical settings for other disease states beyond just HCV. TRIAL REGISTRATION Registered on ClinicalTrials.gov on July, 14, 2022. Identifier: NCT05460130 .
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Affiliation(s)
- Anmol Desai
- Department of Population Health, The University of Texas at Austin Dell Medical School, Austin, USA
| | - Lauren O'Neal
- The University of Texas at Austin Dell Medical School, Austin, USA
| | - Kia Reinis
- Department of Population Health, The University of Texas at Austin Dell Medical School, Austin, USA
| | - Patrick Chang
- Department of Population Health, The University of Texas at Austin Dell Medical School, Austin, USA
| | - Cristal Brown
- Department of Internal Medicine, The University of Texas at Austin Dell Medical School, Austin, USA
- CommUnityCare Health Centers, Austin, USA
| | - Michael Stefanowicz
- Department of Population Health, The University of Texas at Austin Dell Medical School, Austin, USA
- CommUnityCare Health Centers, Austin, USA
| | - Audrey Kuang
- Department of Population Health, The University of Texas at Austin Dell Medical School, Austin, USA
- Department of Internal Medicine, The University of Texas at Austin Dell Medical School, Austin, USA
- CommUnityCare Health Centers, Austin, USA
| | - Deepak Agrawal
- Department of Internal Medicine, The University of Texas at Austin Dell Medical School, Austin, USA
| | - Darlene Bhavnani
- Department of Population Health, The University of Texas at Austin Dell Medical School, Austin, USA
| | - Tim Mercer
- Department of Population Health, The University of Texas at Austin Dell Medical School, Austin, USA.
- Department of Internal Medicine, The University of Texas at Austin Dell Medical School, Austin, USA.
- CommUnityCare Health Centers, Austin, USA.
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Ydreborg M, Lundström E, Kolleby R, Lexén S, Pizarro E, Lindgren J, Wejstål R, Larsson SB. Linkage to hepatitis C treatment in two opioid substitution treatment units in Gothenburg, Sweden: a retrospective cohort study. Subst Abuse Treat Prev Policy 2023; 18:17. [PMID: 36907872 PMCID: PMC10009929 DOI: 10.1186/s13011-023-00527-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Accepted: 03/07/2023] [Indexed: 03/14/2023] Open
Abstract
BACKGROUND Chronic infection with the hepatitis C virus (HCV) is common in people with former or current injection drug use. Among the patients in the opioid substitution treatment (OST) program in Gothenburg, Sweden, more than 50% had been infected with HCV. However, many patients did not have any follow-up for their infection and the linkage to treatment could be improved. METHODS A model of care for HCV was introduced at an OST unit in Gothenburg, Sweden, in 2017. The aim was to increase testing and linkage to HCV treatment. A nurse and a medical doctor, both specialized in infectious diseases, performed on-site testing at the OST unit with transient liver elastography (Fibroscan) to evaluate the fibrosis stage and initiated HCV treatment. This study retrospectively reviewed the patients' medical records to assess information regarding participation in the model of care, hepatitis C status, linkage to treatment and treatment outcome. RESULTS Among the 225 patients enrolled in OST at baseline, 181 were still in the OST program at the end of study (December 31st, 2018). In total, 29 patients, most of whom did not attend the Clinic of Infectious Diseases, were referred to the model of care. By the end of study, 17 patients (100% of those treated) reached sustained virologic response. In parallel, an additional 19 patients got treatment directly at the Clinic of Infectious Diseases. CONCLUSION Integrating HCV screening and examination in an OST unit successfully linked patients to treatment. However, not all patients received treatment. To reach the goal of eliminating HCV, different models of care are needed.
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Affiliation(s)
- Magdalena Ydreborg
- Department of Infectious Diseases, Sahlgrenska Academy, University of Gothenburg, Box 480, 405 30, Gothenburg, Sweden
- Clinic of Infectious Diseases, Sahlgrenska University Hospital, Region Västra Götaland, Journalvägen, 10 416 50, Gothenburg, Sweden
| | - Emil Lundström
- Department of Addiction and Dependency, Sahlgrenska University Hospital, Region Västra Götaland, Journalvägen, 5 416 85, Gothenburg, Sweden
| | - Rosanna Kolleby
- Clinic of Infectious Diseases, Sahlgrenska University Hospital, Region Västra Götaland, Journalvägen, 10 416 50, Gothenburg, Sweden
| | - Sofia Lexén
- Department of Addiction and Dependency, Sahlgrenska University Hospital, Region Västra Götaland, Journalvägen, 5 416 85, Gothenburg, Sweden
| | - Elena Pizarro
- Department of Addiction and Dependency, Sahlgrenska University Hospital, Region Västra Götaland, Journalvägen, 5 416 85, Gothenburg, Sweden
| | - Jessica Lindgren
- Department of Addiction and Dependency, Sahlgrenska University Hospital, Region Västra Götaland, Journalvägen, 5 416 85, Gothenburg, Sweden
| | - Rune Wejstål
- Department of Infectious Diseases, Sahlgrenska Academy, University of Gothenburg, Box 480, 405 30, Gothenburg, Sweden
- Clinic of Infectious Diseases, Sahlgrenska University Hospital, Region Västra Götaland, Journalvägen, 10 416 50, Gothenburg, Sweden
| | - Simon B Larsson
- Department of Infectious Diseases, Sahlgrenska Academy, University of Gothenburg, Box 480, 405 30, Gothenburg, Sweden.
- Department of Addiction and Dependency, Sahlgrenska University Hospital, Region Västra Götaland, Journalvägen, 5 416 85, Gothenburg, Sweden.
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Kapadia SN, Eckhardt BJ, Leff JA, Fong C, Mateu-Gelabert P, Marks KM, Aponte-Melendez Y, Schackman BR. Cost of providing co-located hepatitis C treatment at a syringe service program exceeds potential reimbursement: Results from a clinical trial. DRUG AND ALCOHOL DEPENDENCE REPORTS 2022; 5:100109. [PMID: 36644226 PMCID: PMC9836210 DOI: 10.1016/j.dadr.2022.100109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Revised: 09/14/2022] [Accepted: 10/04/2022] [Indexed: 06/17/2023]
Abstract
Background Co-located hepatitis C treatment at syringe service programs (SSP) is an emerging model of care for people who inject drugs (PWID). Implementation of these models can be informed by understanding the program costs. Methods We conducted an economic evaluation of a hepatitis C treatment intervention at an SSP in New York City implemented as one arm of a randomized trial from 2017 to 2021. Start-up and operating costs were determined from the treatment program's perspective using micro-costing and were compared to potential Medicaid reimbursement. We applied nationally representative unit costs and wage rates. Results are reported in 2020 USD. Results The treatment program was staffed by one physician and one care coordinator. Participants were offered hepatitis C clinical evaluation and treatment, a 45-min reinfection prevention education session, and additional care coordination as needed. The trial enrolled 84 PWID with hepatitis C in the intervention arm; 64 initiated treatment and 55 achieved sustained virological response. Start-up costs including training and equipment totaled $4677. Overhead costs including rent, utilities and software totaled $2229 per month. Clinical and care coordination totaled $4867 per participant, of which $3722 was care coordination. The total cost excluding startup was $6035 per enrolled participant and $7921 per treated participant; estimated potential reimbursement was $628 per enrolled participant. Conclusion Our results provide insight to US-based SSPs seeking to provide co-located hepatitis C care and highlight the intensive care coordination services provided. Successful implementation likely requires funding sources beyond health insurers or substantial changes to insurance reimbursement for care coordination.
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Affiliation(s)
- Shashi N Kapadia
- Weill Cornell Medicine, Division of Infectious Diseases, 1300 York Ave Rm A-421, New York, NY 10065, United States
- Weill Cornell Medicine, Department of Population Health Sciences, 425 E 61st Street, Ste 301, New York, NY 10065, United States
| | - Benjamin J Eckhardt
- Division of Infectious Diseases, New York University Grossman School of Medicine, 550 First Avenue, New York, NY 10016, United States
| | - Jared A Leff
- Weill Cornell Medicine, Department of Population Health Sciences, 425 E 61st Street, Ste 301, New York, NY 10065, United States
| | - Chunki Fong
- CUNY Graduate School of Public Health and Health Policy, 55W 125th Street, New York, NY 10027, United States
| | - Pedro Mateu-Gelabert
- CUNY Graduate School of Public Health and Health Policy, 55W 125th Street, New York, NY 10027, United States
| | - Kristen M Marks
- Weill Cornell Medicine, Division of Infectious Diseases, 1300 York Ave Rm A-421, New York, NY 10065, United States
| | - Yesenia Aponte-Melendez
- CUNY Graduate School of Public Health and Health Policy, 55W 125th Street, New York, NY 10027, United States
- New York University Rory Meyers College of Nursing, 433 1st Avenue, New York, NY 10010, United States
| | - Bruce R Schackman
- Weill Cornell Medicine, Department of Population Health Sciences, 425 E 61st Street, Ste 301, New York, NY 10065, United States
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Sirpal S, Chandok N. Barriers to hepatitis C diagnosis and treatment in the DAA era: Preliminary results of a community-based survey of primary care practitioners. CANADIAN LIVER JOURNAL 2022; 5:96-100. [DOI: 10.3138/canlivj-2021-0032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2021] [Accepted: 10/02/2021] [Indexed: 11/20/2022]
Abstract
Notwithstanding the groundbreaking achievement of hepatitis C curative treatment with direct-acting antiviral therapies, Canada faces an uphill battle in reaching the 2030 goal of viral elimination set forth by the World Health Organization, a goal made more difficult by the COVID-19 pandemic. There is limited understanding of the diagnostic and treatment barriers, and challenges in linkage to care in Canada, especially as it pertains to primary care providers in a community context. Therefore, in this article, the authors conducted a survey study to evaluate the following factors: primary care providers’ knowledge of specialist treatment options and the importance of screening and treatment; and patient factors, including transportation, linguistic barriers, and other socio-economic status indicators that impact the screening and management of hepatitis C. The results suggest that public health campaigns that protocolize and/or incentivize screening and referrals may provide solutions to addressing such barriers.
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Affiliation(s)
- Sanjeev Sirpal
- Department of Emergency Medicine, CIUSSS du Nord-de-l’Île-de-Montréal, Montréal, Québec, Canada
| | - Natasha Chandok
- Division of Gastroenterology, Department of Medicine, Brampton Civic Hospital, Brampton, Ontario, Canada
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Ward Z, Reynolds R, Campbell L, Martin NK, Harrison G, Irving W, Hickman M, Vickerman P. Cost-effectiveness of the HepCATT intervention in specialist drug clinics to improve case-finding and engagement with HCV treatment for people who inject drugs in England. Addiction 2020; 115:1509-1521. [PMID: 31984606 PMCID: PMC10762643 DOI: 10.1111/add.14978] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2019] [Revised: 10/04/2019] [Accepted: 01/17/2020] [Indexed: 12/23/2022]
Abstract
BACKGROUND AND AIMS People who inject drugs (PWID) are at high risk of hepatitis C virus (HCV) infection; however, ~50% are undiagnosed in England and linkage-to-care is poor. This study investigated the cost-effectiveness of an intervention (HepCATT) to improve case-finding and referral to HCV treatment compared with standard-of-care pathways in drug treatment centres in England. DESIGN HCV transmission and disease progression model with cost-effectiveness analysis using a health-care perspective. Primary outcome and cost data from the HepCATT study parameterized the intervention, suggesting that HepCATT increased HCV testing in drug treatment centres 2.5-fold and engagement onto the HCV treatment pathway 10-fold. A model was used to estimate the decrease in HCV infections and HCV-related deaths from 2016, with costs and health benefits (quality-adjusted life-years or QALYs) tracked over 50 years. Univariable and probabilistic sensitivity analyses (PSA) were undertaken. SETTING England-specific epidemic with 40% prevalence of chronic HCV among PWID. PARTICIPANTS PWID attending drug treatment centres. INTERVENTION Nurse facilitator in drug treatment centres to improve the HCV care pathway from HCV case-finding to referral and linkage to specialist care. Comparator was the standard-of-care HCV care pathway. MEASUREMENTS Incremental cost-effectiveness ratio (ICER) in terms of cost per QALY gained through improved case-finding. FINDINGS Over 50 years per 1000 PWID, the HepCATT intervention could prevent 75 (95% central interval 37-129) deaths and 1330 (827-2040) or 51% (30-67%) of all new infections. The mean ICER was £7986 per QALY gained, with all PSA simulations being cost-effective at a £20 000 per QALY willingness-to-pay threshold. Univariable sensitivity analyses suggest the intervention would become cost-saving if the cost of HCV treatment reduces to £3900. If scaled up to all PWID in England, the intervention would cost £8.8 million and decrease incidence by 56% (33-70%) by 2030. CONCLUSIONS Increasing hepatitis C virus infection case-finding and treatment referral in drug treatment centres could be a highly cost-effective strategy for decreasing hepatitis C virus incidence among people who inject drugs.
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Affiliation(s)
- Zoe Ward
- Population Health Sciences, Bristol Medical School, University of Bristol, UK
| | - Rosie Reynolds
- Population Health Sciences, Bristol Medical School, University of Bristol, UK
| | - Linda Campbell
- Population Health Sciences, Bristol Medical School, University of Bristol, UK
| | - Natasha K. Martin
- Division of Infectious Diseases and Global Public Health, University of California, San Diego, CA, USA
| | | | - William Irving
- Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Matthew Hickman
- Population Health Sciences, Bristol Medical School, University of Bristol, UK
| | - Peter Vickerman
- Population Health Sciences, Bristol Medical School, University of Bristol, UK
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Co-Located hepatitis C virus infection treatment within an opioid treatment program promotes opioid agonist treatment retention. Drug Alcohol Depend 2020; 213:108116. [PMID: 32599493 DOI: 10.1016/j.drugalcdep.2020.108116] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Revised: 06/08/2020] [Accepted: 06/08/2020] [Indexed: 12/25/2022]
Abstract
BACKGROUND Co-located treatment for hepatitis C virus (HCV) infection for patients with opioid use disorder (OUD) within an opioid treatment program (OTP) addresses gaps in the HCV care continuum. Few reports have analyzed outcomes related to OUD treatment, such as retention, associated with co-located HCV treatment. METHODS Patients (n = 89) treated for OUD and chronic HCV infection in a Northeast US OTP from January 2014 through July 2017 were compared to control patients (n = 199) being treated for OUD and diagnosed with but not treated for HCV during the same period. All patients received opioid agonist treatment (OAT). The outcome of interest is patient retention in the OTP from January 2014 through September 2018, analyzed using logistic regression and survival analysis based on OTP loss to follow-up dates. RESULTS After adjusting for baseline covariates, patients who completed HCV treatment had 2.22 (95 % CI: 1.11, 4.45) increased likelihood of remaining in the OTP compared to patients in the control group. Survival analysis indicated the HCV treatment group had a significantly greater probability of being retained over the duration of the study compared with the control group. CONCLUSION Results indicate that a co-located model of care is associated with improved OTP treatment retention following HCV treatment, and suggest that co-locating HCV and OUD treatment has a secondary impact on keeping patients engaged in OAT.
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Murphy SM, Jeng PJ, Poole SA, Jalali A, Vocci FJ, Gordon MS, Woody GE, Polsky D. Health and economic outcomes of treatment with extended-release naltrexone among pre-release prisoners with opioid use disorder (HOPPER): protocol for an evaluation of two randomized effectiveness trials. Addict Sci Clin Pract 2020; 15:15. [PMID: 32321570 PMCID: PMC7178627 DOI: 10.1186/s13722-020-00188-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2019] [Accepted: 04/08/2020] [Indexed: 01/26/2023] Open
Abstract
BACKGROUND Persons with an opioid use disorder (OUD) who were incarcerated face many challenges to remaining abstinent; concomitantly, opioid-overdose is the leading cause of death among this population, with the initial weeks following release proving especially fatal. Extended-release naltrexone (XR-NTX) is the most widely-accepted, evidence-based OUD pharmacotherapy in criminal justice settings, and ensures approximately 30 days of protection from opioid overdose. The high cost of XR-NTX serves as a barrier to uptake by many prison/jail systems; however, the cost of the medication should not be viewed in isolation. Prison/jail healthcare budgets are ultimately determined by policymakers, and the benefits/cost-offsets associated with effective OUD treatment will directly and indirectly affect their overall budgets, and society as a whole. METHODS This protocol describes a study funded by the National Institute of Drug Abuse (NIDA) to: evaluate changes in healthcare utilization, health-related quality-of-life, and other resources associated with different strategies of XR-NTX delivery to persons with OUD being released from incarceration; and estimate the relative "value" of each strategy. Data from two ongoing, publicly-funded, randomized-controlled trials will be used to evaluate these questions. In Study A, (XR-NTX Before vs. After Reentry), participants are randomized to receive their first XR-NTX dose before release, or at a nearby program post-release. In Study B, (enhanced XR-NTX vs. XR-NTX), both arms receive XR-NTX prior to release; the enhanced arm receives mobile medical (place of residence) XR-NTX treatment post-release, and the XR-NTX arm receives referral to a community treatment program post-release. The economic data collection instruments required to evaluate outcomes of interest were incorporated into both studies from baseline. Moreover, because the same instruments are being used in both trials on comparable populations, we have the opportunity to not only assess differences in outcomes between study arms within each trial, but also to merge the data sets and test for differences across trials. DISCUSSION Initiating XR-NTX for OUD prior to release from incarceration may improve patient health and well-being, while also producing downstream cost-offsets. This study offers the unique opportunity to assess the effectiveness and cost-effectiveness of multiple strategies, according to different stakeholder perspectives.
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Affiliation(s)
- Sean M Murphy
- Department of Population Health Sciences, Weill Cornell Medical College, 425 East 61st Street, Suite 301, New York, NY, 10065, USA.
| | - Philip J Jeng
- Department of Population Health Sciences, Weill Cornell Medical College, 425 East 61st Street, Suite 301, New York, NY, 10065, USA
| | - Sabrina A Poole
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Ali Jalali
- Department of Population Health Sciences, Weill Cornell Medical College, 425 East 61st Street, Suite 301, New York, NY, 10065, USA
| | | | | | - George E Woody
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Daniel Polsky
- Department of Health Policy and Management, Bloomberg School of Public Health, Carey Business School, Johns Hopkins University, Baltimore, MD, USA
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