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.

Background: Eliminating hepatitis C virus requires efficient testing and treatment strategies. We evaluated cost-effectiveness of alternative hepatitis C virus diagnosis and treatment initiation approaches for treatment-naive people who inject drugs attending Australian community settings. Methods: We compared 7 strategies differing by use of antibody screening, laboratory, and/or point-of-care tests, and point of treatment commencement. Outcomes were treatment initiation and completion. We considered costs from a healthcare sector perspective at a 1-year time horizon. We used decision analytical models parameterized with publicly available estimates. Results: Standard of care laboratory antibody then RNA testing on separate samples was cheapest but least effective. Laboratory antibody then reflex RNA testing on 1 sample provided higher effectiveness and was the only strategy to reduce average cost per completion ($6141 2023AUD; 95% confidence interval, $3924-$10,382). Combined point-of-care antibody and RNA testing, point-of-care RNA alone, and point-of-care antibody with immediate treatment initiation in turn provided incremental improvements in completion at higher average costs per completion (point estimates: $6976-$11 707AUD). Changes in treatment uptake of at least 16 points were required to achieve equivalence between reflex laboratory and point-of-care strategies. Although treatment of nonviremic individuals contributed to higher costs of point-of-care strategies, reflex laboratory testing remained less costly per completion at generic medication costs. Conclusions: Reflex RNA testing was the most efficient strategy and can be implemented within the existing Australian laboratory framework. Point-of-care approaches may provide additional benefit at higher near-term costs. Studies accounting for transmission and disease sequelae are needed to understand cost-effectiveness in the longer term.