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Optimizing Point-of-Care Testing Strategies for Diagnosis and Treatment of Hepatitis C Virus Infection in Australia: A Model-Based Cost-Effectiveness Analysis

33 Pages Posted: 21 Dec 2022

See all articles by Sophy TF Shih

Sophy TF Shih

University of New South Wales (UNSW) - Kirby Institute

Qinglu Cheng

University of New South Wales (UNSW) - Kirby Institute

Joanne Carson

University of New South Wales (UNSW) - Kirby Institute

Heather Valerio

University of New South Wales (UNSW) - Kirby Institute

Yumi Sheehan

University of New South Wales (UNSW) - Kirby Institute

Richard T. Gray

University of New South Wales (UNSW) - Kirby Institute

Evan B. Cunningham

University of New South Wales (UNSW) - Kirby Institute

Jisoo Amy Kwon

University of New South Wales (UNSW) - Kirby Institute

Andrew R. Lloyd

University of New South Wales (UNSW) - Kirby Institute

Gregory J. Dore

University of New South Wales (UNSW) - Kirby Institute

Virginia Wiseman

University of New South Wales (UNSW) - Kirby Institute

Jason Grebely

University of New South Wales (UNSW) - Kirby Institute

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Multiple version iconThere are 2 versions of this paper

Abstract

Background: Timely diagnosis and treatment of hepatitis C virus (HCV) is critical to achieve elimination goals. This study evaluated the cost-effectiveness of point-of-care testing strategies for HCV compared to laboratory-based testing in standard of care.

Methods: Cost-effectiveness analyses were undertaken from the perspective of Australian Governments as funders by modelling point-of-care testing strategies compared to standard of care in needle and syringe programs, drug treatment clinics, and prisons. Point-of-care testing strategies included immediate point-of-care HCV RNA testing and combined point-of-care HCV antibody and reflex RNA testing for HCV antibody positive people (with and without consideration of previous treatment). Sensitivity analyses were performed to investigate the cost per treatment initiation with different testing strategies at different HCV antibody prevalence levels.

Findings: The average costs per HCV treatment initiation by point-of-care testing were up to 35% lower (A$890–A$1,406) compared to standard of care (A$1,248–A$1,632) depending on settings. The average costs per treatment initiation by point-of-care testing were A$1,080–A$1,406 for RNA, A$960–A$1,310 for combined antibody/RNA without treatment history consideration, and A$890– A$1,189 for combined antibody/RNA with treatment history consideration. When HCV antibody prevalence was <74%, combined point-of-care HCV antibody and point-of-care RNA testing (with and without consideration of treatment history) were the most cost-effective strategies. Modest increases in treatment uptake by 8%-31% were required for immediate point-of-care HCV RNA testing to achieve equivalent cost per treatment initiation compared to standard of care.

Interpretation: Point-of-care testing is more cost-effective than standard of care for populations at risk of HCV. Testing strategies combining point-of-care HCV antibody and RNA testing are likely to be cost-effective in most settings.

Funding: National Health and Medical Research Council

Declaration of Interest: RTG has received funding for his research from WHO and has provided non-funded project advice to Gilead and ViiV. YS is a co-investigator on investigatorinitiated research grants from AbbVie and Gilead Sciences. ARL has received investigatorinitiated research grants from AbbVie, Gilead Sciences, and Sequiris. GJD is a consultant/advisor and has received research grants from Abbvie, Abbot Diagnostics, Gilead Sciences, Bristol Myers Squibb, Cepheid, GlaxoSmithKline, Merck, Janssen and Roche. JG is a consultant/advisor and has received research grants from AbbVie, Biolytical, Camurus, Cepheid, Gilead Sciences, Hologic, Indivor, and Merck/MSD and has received honoraria from AbbVie, Cepheid, Gilead Sciences, and Merck. No input into this work was provided by any of the above listed organisations or institutions. All other authors have no conflicts of interest to declare.

Keywords: HCV, health economics, modelling, antibody testing, RNA testing

Suggested Citation

Shih, Sophy TF and Cheng, Qinglu and Carson, Joanne and Valerio, Heather and Sheehan, Yumi and Gray, Richard T. and Cunningham, Evan B. and Kwon, Jisoo Amy and Lloyd, Andrew R. and Dore, Gregory J. and Wiseman, Virginia and Grebely, Jason, Optimizing Point-of-Care Testing Strategies for Diagnosis and Treatment of Hepatitis C Virus Infection in Australia: A Model-Based Cost-Effectiveness Analysis. Available at SSRN: https://ssrn.com/abstract=4267527 or http://dx.doi.org/10.2139/ssrn.4267527

Sophy TF Shih (Contact Author)

University of New South Wales (UNSW) - Kirby Institute ( email )

Qinglu Cheng

University of New South Wales (UNSW) - Kirby Institute ( email )

Joanne Carson

University of New South Wales (UNSW) - Kirby Institute ( email )

Heather Valerio

University of New South Wales (UNSW) - Kirby Institute ( email )

Yumi Sheehan

University of New South Wales (UNSW) - Kirby Institute ( email )

Richard T. Gray

University of New South Wales (UNSW) - Kirby Institute

Evan B. Cunningham

University of New South Wales (UNSW) - Kirby Institute ( email )

Jisoo Amy Kwon

University of New South Wales (UNSW) - Kirby Institute ( email )

Sydney
Australia

Andrew R. Lloyd

University of New South Wales (UNSW) - Kirby Institute ( email )

Sydney
Australia

Gregory J. Dore

University of New South Wales (UNSW) - Kirby Institute ( email )

Sydney
Australia

Virginia Wiseman

University of New South Wales (UNSW) - Kirby Institute ( email )

Australia

Jason Grebely

University of New South Wales (UNSW) - Kirby Institute ( email )

Australia

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