Objective:

To evaluate the cost-effectiveness of different hepatitis C virus diagnosis and treatment initiation strategies for treatment-naive individuals who inject drugs in Australian community settings, highlighting the importance of these strategies in the context of hepatitis C elimination efforts.

Key Findings:

• Standard of care laboratory antibody then RNA testing was the cheapest but least effective, indicating a trade-off between cost and effectiveness.
• Laboratory antibody then reflex RNA testing on one sample was the most effective and reduced average cost per completion, suggesting a more efficient use of resources.
• Point-of-care strategies provided incremental improvements in treatment completion at higher costs, highlighting the need for careful consideration of budget impacts.
• Reflex RNA testing was identified as the most efficient strategy, emphasizing its potential role in optimizing hepatitis C management.

Interpretation:

Reflex laboratory testing remains less costly per completion compared to point-of-care strategies, although point-of-care approaches may offer additional benefits at higher costs, warranting further exploration of their long-term value.

Limitations:

• The analysis considered only a 1-year time horizon, which may limit the applicability of findings to long-term strategies. Additionally, it did not account for long-term transmission and disease sequelae, which are critical for comprehensive cost-effectiveness assessments.

Conclusion:

Reflex RNA testing is the most efficient strategy for hepatitis C diagnosis and treatment initiation, while point-of-care methods may enhance treatment uptake despite higher costs, underscoring the need for a balanced approach in policy-making.