Theme: Epidemiology & Public Health Research Year: 2019
Background: People who inject drugs (PWID) have a high risk of hepatitis C virus (HCV) infection.
HCV treatment is essential for eliminating HCV but has limited coverage in resource-limited
countries. For the first time in Sub-Saharan Africa, we evaluated the cost-effectiveness of a pilot HCV
screening and direct acting antiviral (DAA)-based HCV treatment intervention among PWID in
Nairobi, Kenya.
Methods: We utilised a previously developed and calibrated dynamic compartmental model of HIV
and HCV transmission amongst current and former PWID in Nairobi to estimate the costeffectiveness of the treatment intervention including prevention benefits. The effectiveness (SVR) of
treatment and costs for testing and treatment were estimated from intervention data, while other
model parameters were derived from literature. The incremental cost-effectiveness ratio (ICER) was
estimated in terms of cost per disability adjusted life year (DALY) averted over a lifetime horizon
from the provider’s perspective. One-way and probabilistic sensitivity analyses (PSA) were
performed.
Results: During the intervention, 81 individuals were treated with 73 (90.1%) confirmed to have
achieved a SVR at 12 weeks. The ICER for the intervention was US$805/DALY averted, with 99.5% of
PSA runs below the World Health Organization threshold for cost-effective interventions for Kenya
(US$1,509). Sensitivity analyses showed the intervention became not cost-effective if we assumed a
shorter time horizon (25 years, US$2,742/DALY) or higher discount rate (5% instead of 3%,
US$1,551/DALY), but became more cost-effective with a reduction in the price paid for DAAs from
$728 to $160 per course of treatment (US$661/DALY) or if the costs associated with undertaking
directly observed treatment (DOT) were removed US$543/DALY).
Conclusion: The current strategy of screening and treatment for HCV among PWID in Nairobi is likely
to be cost-effective but could be made much cheaper through not using DOT and negotiating a
cheaper price for DAAs, as achieved elsewhere.
Conflicts of Interest: Dr Stone has received non-financial support from Gilead Sciences