People who inject drugs (PWID) often become infected with HIV and hepatitis C virus (HCV). While hepatitis C can be successfully treated with medication, care is often fragmented and rarely integrated within one program or setting. Two recent studies by CHERISH researchers modeled economic and health outcomes for PWID and found evidence of synergistic benefits when care for opioid use disorder (OUD) and HCV are integrated.
In a recent study published in the International Journal of Drug Policy, CHERISH research affiliate Joshua Barocas and colleagues compared offsite referral for OUD treatment to onsite office-based buprenorphine-naloxone (BUP-NX) for HIV patients offered onsite HCV treatment in an HIV care clinic. Using a micro-simulation model, informed by literature, they found that offering BUP-NX onsite improved HCV outcomes including lifetime prevalence of cirrhosis. Compared to offsite OUD treatment referral, the integrated program reduced active injection drug use, which, in turn, reduced the risk of HCV re-infections by 7%. Most notably, integrating BUP-NX reduced projected liver-related deaths and non-liver related deaths in the first year of treatment and in the five years after beginning treatment, which increased the life expectancy of PWID. The increase in life expectancy was largely driven by a reduction in short- and long- term non-liver related deaths, such as opioid overdose deaths. Integrated BUP-NX care had a cost-effectiveness ratio of $57,100 per quality-adjusted life year compared to offsite referral to OUD treatment, which is well below the accepted willingness-to-pay threshold in the US.
Providing HCV care onsite in OUD treatment settings can also improve HCV-related outcomes. In a recent clinical trial, investigators randomized participants to one of three onsite HCV treatment models in a methadone maintenance treatment setting. Individuals received HCV medication at the treatment program on a monthly basis during a provider visit, on a weekly basis in a group therapy setting or on a daily basis at a methadone-dispensing window. The clinical trial found high treatment adherence and rates of treatment success among the participants. Sarah Gutkind and CHERISH colleagues compared the three onsite HCV treatment strategies to offsite HCV treatment referrals, in a recent modeling study published in Clinical Infectious Diseases. Using clinical trial outcomes to inform the model, the authors found that only 22% of people in the simulated offsite treatment referral arm were treated successfully, whereas 86-89% of individuals in the onsite treatment HCV treatment strategies achieved treatment success. Benefits included improved quality of life and quality-adjusted life years gained. Administering HCV treatment in a concurrent group therapy setting was the most cost-effective strategy, with a cost-effectiveness ratio of $34,300 per quality-adjusted life year compared to offsite referral.
Both studies highlight the health and economic benefits of integrating onsite HCV and OUD treatment, resulting in substantial lifetime benefits. Both care integration models present opportunities to reach and treat vulnerable patients with co-occurring HCV and OUD.