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Cost-effectiveness of low dead space detachable syringes for the prevention of Hepatitis C

Cost-effectiveness of low dead space detachable syringes for the prevention of Hepatitis C. Elizabeth Hancock 1 , Zoe Ward 2 , Rachel Ayres 3 , Jo Keston 2 , Jane Neale 3 , Matthew Hickman 2 , Peter Vickerman 2 1 Source Heor, 2 University of Bristol, 3 Bristol Drugs Project, UK.

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Cost-effectiveness of low dead space detachable syringes for the prevention of Hepatitis C

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  1. Cost-effectiveness of low dead space detachable syringes for the prevention of Hepatitis C Elizabeth Hancock1, Zoe Ward2, Rachel Ayres3, Jo Keston2, Jane Neale3, Matthew Hickman2, Peter Vickerman2 1 Source Heor, 2 University of Bristol, 3 Bristol Drugs Project, UK

  2. Disclosures • PV has received research grants unrelated to this work from Gilead • Unrelated to this work, PV has received honoraria from Abbvie, and MH has received honoraria from Merck, Abbvie and Gilead

  3. Background – Syringe types • People who inject drugs use two styles of syringes • Syringes with fixed needles which have low dead space (LDSS) • Syringes with detachable needles which have high dead space (HDSS)

  4. Background – New syringes Standard HDSS Two lower dead space detachable options Standard LDSS • New lower dead space detachable options available • These reduce the dead space compared to HDSS

  5. Aims • In Bristol (UK), the new detachable syringes with lower dead space were introduced and offered alongside standard HDSS and LDSS • This study evaluated the cost-effectiveness of introducing these lower dead space detachable syringes in preventing Hepatitis C transmission

  6. Intervention and Comparator • Prior to intervention 38% of all syringes distributed were HDSS or detachable (Comparator) • Bristol Drugs Project started distributing detachable LDSS • Education posters • Training staff to promote new syringes • In first year 3% of all syringes distributed were detachable LDSS replacing former HDSS

  7. Costs • Direct costs of the intervention included staff time and training (41 hours) • Increased syringe costs (£0.033 vs £0.025 for HDSS) • Indirect costs of HCV care and treatment calculated from infectious disease model

  8. Model • Dynamic HCV transmission and progression model • Demographic and epidemiological parameters specific to Bristol • Assume detachable LDSS decrease HCV transmission risk by 84% • Used to calculate indirect costs of intervention and quality adjusted life years (QALYs) Vickerman (2013), DeCarli (2003), Thomas (2000)

  9. Analysis Methods • The intervention modelled for 10 years and capture outcomes for a further 40 years • Incremental cost-effectiveness ratio calculated and compared to UK willingness to pay threshold of £20,000 per QALY • Threshold analysis on reduction in HCV transmission risk needed with detachable LDSS to ensure cost-effectiveness • Probabilistic sensitivity analysis to assess impact of uncertainty around important parameters • Test how increase in uptake of detachable LDSS impacts cost-effectiveness

  10. Results • Direct intervention costs: £6000 over 10 years • Saves 261 QALYs over 50 years • Averts £1.6 million in HCV treatment (68%) and care costs (32%) • ICER is cost-saving which means the intervention gives more health benefit and costs less than the comparator

  11. Probabilistic sensitivity analysis Incremental QALYs 0 100 200 300 400 500 600 700 £0 All simulations in cost-saving quadrant Incremental Costs (£million) -£2M -£4M

  12. Threshold analysis • Base case assumed 84% reduction in HCV transmission risk (new detachable LDSS v’s traditional detachable HDSS): • Result suggested intervention was cost saving • If assume different percentage reductions in HCV transmission risk, then detachable LDSS only have to reduce transmission risk of HDSS by • 0.3% to be cost saving • 0.08% to be cost-effective at £20,000 per QALY threshold

  13. Scenario Analysis of detachable LDSS uptake • Baseline scenario was an uptake from 0% to 3% of all needles and syringes being detachable LDSS – net monetary benefit of £6,830,258 • Uptake to 10% increased the net monetary benefit by 241% • Other scenarios looking at cheaper HCV treatment or higher treatment rates still cost-saving

  14. Discussion • Expanding use of detachable LDSS could save money and reduce HCV transmission risk • Evidence strongly advocates for their use to be expanded to meet preferences of PWID (i.e. groin injectors) for using detachable syringes • However, there is uncertainty over potential role in reducing transmission • Need better effectiveness data to understand the impact this intervention could have for controlling HCV

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