Cost-effectiveness of hepatitis C screening and treatment linkage intervention in US methadone maintenance treatment programs

Bruce R. Schackman, Sarah Gutkind, Jake R. Morgan, Jared A. Leff, Czarina N. Behrends, Kevin L. Delucchi, Courtney McKnight, David C. Perlman, Carmen L. Masson, Benjamin P. Linas

Research output: Contribution to journalArticle

Abstract

Background: We evaluated the cost-effectiveness of a hepatitis C (HCV) screening and active linkage to care intervention in US methadone maintenance treatment (MMT) patients using data from a randomized trial conducted in New York City and San Francisco. Methods: We used a decision analytic model to compare 1) no intervention; 2) HCV screening and education (control); and 3) HCV screening, education, and care coordination (active linkage intervention). We also explored an alternative strategy wherein HCV/HIV co-infected participants linked elsewhere. Trial data include population characteristics (67% male, mean age 48, 58% HCV infected) and linkage rates. Data from published sources include treatment efficacy and HCV re-infection risk. We projected quality-adjusted life years (QALYs) and lifetime medical costs using an established model of HCV (HEP-CE). Incremental cost-effectiveness ratios (ICERs) are in 2015 US$/QALY discounted 3% annually. Results: The control strategy resulted in a projected 35% linking to care within 6 months and 31% achieving sustained virologic response (SVR). The intervention resulted in 60% linking and 54% achieving SVR with an ICER of $24,600/QALY compared to no intervention from the healthcare sector perspective and was a more efficient use of resources than the control strategy. The intervention had an ICER of $76,500/QALY compared to the alternative strategy. From a societal perspective, the intervention had a net monetary benefit of $511,000–$975,600. Conclusions: HCV care coordination interventions that include screening, education and active linkage to care in MMT settings are likely cost-effective at a conventional $100,000/QALY threshold for both HCV mono-infected and HIV co-infected patients.

Original languageEnglish (US)
Pages (from-to)411-420
Number of pages10
JournalDrug and alcohol dependence
Volume185
DOIs
StatePublished - Apr 1 2018

Keywords

  • Cost-effectiveness
  • Hepatitis C
  • Methadone maintenance therapy

ASJC Scopus subject areas

  • Toxicology
  • Pharmacology
  • Psychiatry and Mental health
  • Pharmacology (medical)

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