Cost-effectiveness of Alternative Approaches to Hepatitis C Diagnosis and Treatment Initiation for Treatment-naive People Who Inject Drugs in Australia: A Model-based Economic Evaluation - Scorecard - MDSpire
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Cost-effectiveness of Alternative Approaches to Hepatitis C Diagnosis and Treatment Initiation for Treatment-naive People Who Inject Drugs in Australia: A Model-based Economic Evaluation
Clinical Scorecard: Economic Evaluation of Various Hepatitis C Diagnosis and Treatment Strategies for Treatment-Naive Individuals Who Inject Drugs in Australia: A Model-Based Analysis
At a Glance
Category
Detail
Condition
Hepatitis C virus infection
Key Mechanisms
Diagnosis via antibody and RNA testing; treatment initiation with direct-acting antivirals
Target Population
Treatment-naive people who inject drugs attending Australian community primary care settings
Care Setting
Community primary care and drug and alcohol services in Australia
Key Highlights
Reflex laboratory RNA testing on a single sample is the most cost-effective strategy, reducing average cost per treatment completion.
Immediate treatment initiation based on point-of-care antibody testing is feasible but may increase costs due to treatment of nonviremic individuals.
Guideline-Based Recommendations
Diagnosis
Use sequential laboratory antibody and RNA testing as standard of care, with reflex RNA testing recommended but not yet routine.
Consider point-of-care antibody and RNA testing to reduce barriers and improve linkage to care.
Management
Initiate treatment promptly after diagnosis, with potential for same-visit treatment initiation in point-of-care settings.
Immediate treatment initiation for antibody-positive individuals with follow-up RNA confirmation may be considered.
Monitoring & Follow-up
Confirm active infection with RNA testing following antibody screening.
Follow up patients started on immediate treatment to discontinue therapy if RNA negative.
Risks
Loss to follow-up due to multiple visits in standard laboratory testing.
Higher costs and potential overtreatment with point-of-care immediate treatment strategies.
Point-of-care tests may be marginally less accurate than laboratory assays.
Patient & Prescribing Data
Treatment-naive people who inject drugs in Australian community settings
Reflex laboratory RNA testing optimizes cost-effectiveness; point-of-care approaches increase treatment uptake but at higher costs; treatment uptake must increase by at least 16 percentage points to match cost-effectiveness of reflex testing.
Clinical Best Practices
Implement reflex RNA testing on the same sample following antibody positivity to reduce loss to follow-up and costs.
Utilize point-of-care testing to improve treatment initiation rates, especially where laboratory access is limited.
Consider immediate treatment initiation strategies with confirmatory RNA testing to enhance uptake but monitor for overtreatment.
Integrate hepatitis C management into primary care and drug and alcohol services to improve accessibility.
Account for local healthcare infrastructure and costs when selecting diagnostic and treatment strategies.
