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Cost-Effectiveness of Rapid Hepatitis C Virus (HCV) Testing and Simultaneous Rapid HCV and HIV Testing in Substance Abuse Treatment Programs.

Addiction 2015;110(1):129-143. [doi: 10.1111/add.12754]

Bruce R. Schackman, PhD (Weill Cornell Medical College, SC Node), Jared A. Leff, MS (Weill Cornell Medical College, SC Node), Devra M. Barter, MS (Boston Medical Center), Madeline A. DiLorenzo, AB (Massachusetts General Hospital), Daniel J. Feaster, PhD (Miller School of Medicine, FNA Node), Lisa R. Metsch, PhD (Columbia University, FNA Node), Kenneth A. Freedberg, MD, MSc (Massachusetts General Hospital), Benjamin P. Linas, MD, MPH (Boston Medical Center).

There are an estimated 3.2 million individuals in the United States who are chronically infected with hepatitis C virus (HCV), of whom only have had an HCV antibody test and less than a quarter have had a confirmatory HCV RNA test. The US Centers for Disease Control and Prevention (CDC) has set a goal to reduce the proportion of HCV-infected individuals unaware of their status from 55% to 33%. This analysis of data from the National Drug Abuse Treatment Clinical Trials Network, study CTN-0032 (HIV Rapid Testing and Counseling), aimed to evaluate the cost-effectiveness of rapid HCV and simultaneous HCV/HIV antibody testing in substance abuse treatment programs. Researcher used a decision analytic model to compare the cost-effectiveness of no HCV testing referral or offer, off-site HCV testing referral, on-site rapid HCV testing offer, and on-site rapid HCV and HIV testing offer. Base case inputs included 11% undetected chronic HCV, 0.4% undetected HIV, 35% HCV co-infection among HIV-infected, 53% linked to HCV care after testing antibody positive, and 67% linked to HIV care. Disease outcomes were estimated from established computer simulation models of HCV (HEP-CE) and HIV (CEPAC). Measurements included lifetime costs (2011 US dollars) and quality-adjusted life years (QALYs) discounted at 3% annually and incremental cost-effective ratios (ICERs).

On-site rapid HCV testing had an ICER of $18,300/QALY compared with no testing, and was more efficient than (dominated) off-site HCV testing referral. On-site rapid HCV and HIV testing had an ICER of $64,500/QALY compared with on-site rapid HCV testing alone. In one and two-way sensitivity analyses, the ICER of on-site rapid HCV and HIV testing remained <$100,000/QALY, except when undetected HIV prevalence was <0.1% or when we assumed frequent HIV testing elsewhere. The ICER remained <$100,000/QALY in approximately 90% of probabilistic sensitivity analyses.

Conclusions: On-site rapid hepatitis C and HIV testing in substance abuse treatment programs is cost-effective at a <$100,000/quality-adjusted life years threshold. On-site rapid HCV and HIV testing in substance abuse treatment programs represents good value as a public health investment. Policymakers should identify ways to improve the capacity of substance abuse treatment programs to implement on-site HCV and HIV testing, bill for these services, and ensure that individuals testing positive for either virus receive further evaluation and treatment. (Article (Peer-Reviewed), PDF, English, 2015)

Keywords: Community health services | Cost-effectiveness | CTN platform/ancillary study | Hepatitis C | HIV/AIDS | HIV rapid testing | Sexual risk behavior | Sexually transmitted diseases | Addiction (journal)

Document No: 1104, PMID: 25291977, PMCID: PMC4270906.

Submitted by CTN Dissemination Librarians, 10/13/2014.

Barter, Devra M. search
DiLorenzo, Madeline A. search
Feaster, Daniel J. search mail
Freedberg, Kenneth A. search
Leff, Jared A. search
Linas, Benjamin P. search
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Schackman, Bruce R. search mail
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