Cost-effectiveness of syringe service programs, medications for opioid use disorder, and combination programs in hepatitis C harm reduction among opioid injection drug users: a public payer perspective using a decision tree
Cost-effectiveness of syringe service programs, medications for opioid use disorder, and combination programs in hepatitis C harm reduction among opioid injection drug users: a public payer perspective using a decision tree
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DOI：
10.18553/jmcp.2021.27.2.137
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发表时间：
2021-02-01
影响因子：
2.1
通讯作者：
Carroll, Norman, V
中科院分区：
文献类型：
--
作者：
Ijioma, Stephen C.;Pontinha, Vasco M.;Carroll, Norman, V
背景：北美注射吸毒者中丙型肝炎病毒的流行率为55.2%，估计有141万人丙型肝炎病毒抗体阳性。研究表明，注射器服务计划(SSP)、阿片类药物使用障碍(MOUD)单独使用或SSP+Moud联合使用在减少阿片类药物注射吸毒者之间的丙型肝炎传播方面是有效的。目的：评估单独使用SSP、Moud Alone和SSP+Moud联合使用在预防美国阿片类药物注射吸毒者丙型肝炎病例中的成本-效果。有效性是以每100个阿片类药物注射器避免丙型肝炎病例的数量为指标。采用了微观成本计算方法，包括直接医疗费用和非医疗费用。成本效益是从公共支付者的角度在一年的时间范围内进行评估的。结果：与不干预相比，每100个阿片类药物注射单位避免每个丙型肝炎病例增加的成本节约如下：SSP+Moud组合=347,573美元；SSP单独使用=363,821美元；Moud单独使用=317,428美元。综合战略的ICER为4699美元，而SSP组的ICER为4699美元。敏感性分析显示，基础病例成本-效果分析结果对SSP和SSP+Moud组注射危险行为的概率、无丙型肝炎病毒不干预的概率、Moud和抗病毒药物的费用的变化敏感。结论：SSP+Moud组合和SSP单独策略主导Moud单独和不干预策略。与不干预策略相比，SSP在每100个阿片类药物注射单位中避免了每个丙型肝炎病例最大的增量成本节省。采用SSP+Moud组合减害策略而不是单独采用SSP的公共支付者将不得不额外支付4,699美元，以避免阿片类药物注射成瘾者中出现额外的丙型肝炎病例。虽然这些减少伤害的计划将在一年的时间框架内提供好处，但最大的好处可能会在未来几年变得明显。
BACKGROUND: The hepatitis C virus (HCV) prevalence rate among injection drug users (IDUs) in North America is 55.2%, with 1.41 million individuals estimated to be HCV-antibody positive. Studies have shown the effectiveness of syringe service programs (SSPs) atone, medications for opioid use disorder (MOUD) alone, or SSP+MOUD combination in reducing HCV transmission among opioid IDUs.OBJECTIVE: To evaluate the cost-effectiveness of SSP alone, MOUD atone, and SSP+ MOUD combination in preventing HCV cases among opioid IDUs in the United States.METHODS: We used a decision tree analysis model based on published literature and publicly available data. Effectiveness was presented as the number of HCV cases avoided per 100 opioid IDUs. A micro-costing approach was undertaken and included both direct medical and nonmedical costs. Cost-effectiveness was assessed from a public payer perspective over a 1-year time horizon. It was expressed as an incremental cost-effectiveness ratio (ICER) and an incremental cost savings per HCV case avoided per 100 opioid IDUs compared with cost savings with "no intervention: Costs were standardized to 2019 U.S. dollars.RESULTS: The incremental cost savings per HCV case avoided per 100 opioid IDUs com-pared with no intervention were as follows: SSP+ MOUD combination =$347,573; SSP alone =$363,821; MOUD alone=$317,428. The ICER for the combined strategy was $4,699 compared with the ICER for the SSP group. Sensitivity analysis showed that the results of the base-case cost-effectiveness analysis were sensitive to variations in the probabilities of injection-risk behavior for the SSP and SSP+ MOUD combination groups, probability of no HCV with no intervention, and costs of MOUD and HCV antiviral medications.CONCLUSIONS: The SSP+ MOUD combination and SSP alone strategies dominate MOUD alone and no intervention strategies. SSP had the largest incremental cost savings per HCV case avoided per 100 opioid IDUs compared with the no intervention strategy. Public payers adopting the SSP+ MOUD combination harm-reduction strategy instead of SSP alone would have to pay an additional $4,699 to avoid an additional HCV case among opioid IDUs. Although these harm-reduction programs wilt provide benefits in a 1-year time frame, the largest benefit may become evident in the years ahead.