Effectiveness and cost-effectiveness of nationwide campaigns for awareness and case finding of hepatitis C targeted at people who inject drugs and the general population in the Netherlands

Abstract

Background Hepatitis C virus infection (HCV) is a serious, but underdiagnosed disease that can generally be treated successfully. Therefore, a nationwide HCV awareness campaign was implemented in the Netherlands targeting people who inject drugs (PWID) in addiction care (‘PWID intervention’) and high-risk groups in the general population (‘public intervention’). The objective of this study is to assess the effectiveness and cost-effectiveness of the interventions used in this campaign. Methods For the ‘PWID’ intervention, all addiction care centres in the Netherlands provided proactive individual HCV consultation and testing. The ‘public intervention’ consisted of health education through mass media and instruction of health care professionals. A Markov chain model was used to estimate incremental cost-effectiveness ratios (ICER, cost per QALY gained). We included a ‘DAA treatment’ scenario to estimate the effect of these treatment strategies on cost-effectiveness. Results The ‘PWID intervention’ identified 257 additional HCV-carriers. The ICER was €9056 (95% CI: €6043–€13,523) when compared to ‘no intervention’. The ‘public intervention’ identified 38 additional HCV-carriers. The ICER was €18,421 (95% CI: €7376–€25,490,119) when compared to ‘no intervention’. Probabilistic sensitivity analysis showed that the probability that the ‘PWID intervention’ was cost-effective was 100%. It also showed a probability of 34% that the ‘public intervention’ did not exceed the Dutch threshold for cost-effectiveness (€20,000). New treatment regimens are likely to improve cost-effectiveness of this strategy. Conclusion In a nationwide HCV awareness and case finding campaign, the intervention targeting PWID was effective and cost-effective. An intervention targeting risk groups in the general population showed only a modest effect and is therefore less likely to be cost-effective.