By Sedona Sweeney, Zoe Ward, Lucy Platt, Lorna Guinness, Matthew Hickman, Vivian Hope, Lisa Maher, Jenny Iversen, Sharon J. Hutchinson, Josie Smith, Rachel Ayres, Ingrid Hainey & Peter Vickerman
To evaluate the costâeffectiveness of needle and syringe programmes (NSPs) compared with no NSPs on hepatitis C virus (HCV) transmission in the United Kingdom.
Costâeffectiveness analysis from a National Health Service (NHS)/healthâprovider perspective, utilizing a dynamic transmission model of HCV infection and disease progression, calibrated using cityâspecific surveillance and survey data, and primary data collection on NSP costs. The effectiveness of NSPs preventing HCV acquisition was based on empirical evidence.
Setting and participants
UK settings with different chronic HCV prevalence among people who inject drugs (PWID): Dundee (26%), Walsall (18%) and Bristol (45%)
Current NSP provision is compared with a counterfactual scenario where NSPs are removed for 10 years and then returned to existing levels with effects collected for 40 years.
HCV infections and cost per qualityâadjusted life year (QALY) gained through NSPs over 50 years.
Compared with a willingnessâtoâpay threshold of £20 000 per QALY gained, NSPs were highly costâeffective over a timeâhorizon of 50 years and decreased the number of HCV incident infections. The mean incremental costâeffectiveness ratio was costâsaving in Dundee and Bristol, and £596 per QALY gained in Walsall, with 78, 46 and 40% of simulations being costâsaving in each city, respectively, with differences driven by coverage of NSP and HCV prevalence (lowest in Walsall). More than 90% of simulations were costâeffective at the willingnessâtoâpay threshold. Results were robust to sensitivity analyses, including varying the timeâhorizon, HCV treatment cost and numbers of HCV treatments per year.
Needle and syringe programmes are a highly effective lowâcost intervention to reduce hepatitis C virus transmission, and in some settings they are costâsaving. Needle and syringe programmes are likely to remain costâeffective irrespective of changes in hepatitis C virus treatment cost and scaleâup.