Cost-Effectiveness of Hepatitis C Diagnosis and Treatment Strategies in Australian PWID

Overview

This model-based analysis evaluated seven hepatitis C virus (HCV) diagnosis and treatment initiation strategies among treatment-naive people who inject drugs (PWID) in Australia. Reflex laboratory RNA testing was identified as the most cost-effective approach, balancing higher treatment completion rates with lower average costs per completion compared to standard and point-of-care strategies.

Background

Hepatitis C elimination requires efficient testing and treatment, particularly among PWID who face barriers to care. Standard care in Australia involves sequential laboratory antibody and RNA testing, often requiring multiple visits and causing loss to follow-up. Point-of-care testing offers rapid results and potential for same-visit treatment initiation but is currently more expensive and slightly less accurate. Optimizing testing and treatment pathways is critical to improving linkage to care and advancing elimination goals.

Data Highlights

Key Findings

• Standard laboratory testing with separate antibody and RNA samples is cheapest but results in the lowest treatment completion rates.
• Reflex RNA testing on the same sample improves effectiveness and reduces average cost per treatment completion.
• Point-of-care testing strategies provide incremental improvements in treatment completion but at higher average costs.
• A minimum 16 percentage point increase in treatment uptake is required for point-of-care strategies to be cost-equivalent to reflex laboratory testing.
• Treatment of nonviremic individuals in point-of-care immediate treatment strategies increases costs.
• Reflex RNA testing can be integrated into existing Australian laboratory infrastructure, offering an efficient and practical approach.

Clinical Implications

Reflex laboratory RNA testing should be prioritized in community settings to optimize cost-effectiveness and treatment completion among PWID. While point-of-care testing may enhance linkage to care and treatment initiation, its higher costs and operational challenges currently limit widespread implementation. Clinicians and policymakers should consider local infrastructure and patient populations when selecting testing strategies.

Conclusion

Reflex RNA testing represents the most efficient hepatitis C diagnosis and treatment initiation strategy for treatment-naive PWID in Australia, balancing cost and effectiveness. Point-of-care approaches may offer additional benefits but require further evaluation of long-term cost-effectiveness and feasibility.

References

1. Economic Evaluation of Various Hepatitis C Diagnosis and Treatment Strategies for Treatment-Naive Individuals Who Inject Drugs in Australia: A Model-Based Analysis