{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,29]],"date-time":"2026-07-29T01:04:32Z","timestamp":1785287072224,"version":"3.55.0"},"reference-count":53,"publisher":"Oxford University Press (OUP)","issue":"9","license":[{"start":{"date-parts":[[2025,8,22]],"date-time":"2025-08-22T00:00:00Z","timestamp":1755820800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2025,8,29]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:sec>\n                  <jats:title>Background<\/jats:title>\n                  <jats:p>Eliminating hepatitis C virus requires efficient testing and treatment strategies. We evaluated cost-effectiveness of alternative hepatitis C virus diagnosis and treatment initiation approaches for treatment-naive people who inject drugs attending Australian community settings.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>We compared 7 strategies differing by use of antibody screening, laboratory, and\/or point-of-care tests, and point of treatment commencement. Outcomes were treatment initiation and completion. We considered costs from a healthcare sector perspective at a 1-year time horizon. We used decision analytical models parameterized with publicly available estimates.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>Standard of care laboratory antibody then RNA testing on separate samples was cheapest but least effective. Laboratory antibody then reflex RNA testing on 1 sample provided higher effectiveness and was the only strategy to reduce average cost per completion ($6141 2023AUD; 95% confidence interval, $3924\u2013$10,382). Combined point-of-care antibody and RNA testing, point-of-care RNA alone, and point-of-care antibody with immediate treatment initiation in turn provided incremental improvements in completion at higher average costs per completion (point estimates: $6976\u2013$11 707AUD). Changes in treatment uptake of at least 16 points were required to achieve equivalence between reflex laboratory and point-of-care strategies. Although treatment of nonviremic individuals contributed to higher costs of point-of-care strategies, reflex laboratory testing remained less costly per completion at generic medication costs.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusions<\/jats:title>\n                  <jats:p>Reflex RNA testing was the most efficient strategy and can be implemented within the existing Australian laboratory framework. Point-of-care approaches may provide additional benefit at higher near-term costs. Studies accounting for transmission and disease sequelae are needed to understand cost-effectiveness in the longer term.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1093\/ofid\/ofaf514","type":"journal-article","created":{"date-parts":[[2025,8,22]],"date-time":"2025-08-22T06:51:27Z","timestamp":1755845487000},"source":"Crossref","is-referenced-by-count":2,"title":["Cost-effectiveness of Alternative Approaches to Hepatitis C Diagnosis and Treatment Initiation for Treatment-naive People Who Inject Drugs in Australia: A Model-based Economic Evaluation"],"prefix":"10.1093","volume":"12","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-5236-0428","authenticated-orcid":false,"given":"Christopher R","family":"Bailie","sequence":"first","affiliation":[{"name":"Disease Elimination Program, Burnet Institute , Melbourne, Victoria ,","place":["Australia"]},{"name":"Doherty Institute, University of Melbourne , Melbourne, Victoria ,","place":["Australia"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nick","family":"Scott","sequence":"additional","affiliation":[{"name":"Disease Elimination Program, Burnet Institute , Melbourne, Victoria ,","place":["Australia"]},{"name":"School of Public Health and Preventive Medicine, Monash University , Melbourne, Victoria ,","place":["Australia"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1998-5722","authenticated-orcid":false,"given":"Alisa E","family":"Pedrana","sequence":"additional","affiliation":[{"name":"Disease Elimination Program, Burnet Institute , Melbourne, Victoria ,","place":["Australia"]},{"name":"School of Public Health and Preventive Medicine, Monash University , Melbourne, Victoria ,","place":["Australia"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Margaret E","family":"Hellard","sequence":"additional","affiliation":[{"name":"Disease Elimination Program, Burnet Institute , Melbourne, Victoria ,","place":["Australia"]},{"name":"Doherty Institute, University of Melbourne , Melbourne, Victoria ,","place":["Australia"]},{"name":"School of Public Health and Preventive Medicine, Monash University , Melbourne, Victoria ,","place":["Australia"]},{"name":"Department of Infectious Diseases, Alfred Health and Monash University , Melbourne, Victoria ,","place":["Australia"]},{"name":"Melbourne School of Population and Global Health, University of Melbourne , Melbourne, Victoria ,","place":["Australia"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joseph S","family":"Doyle","sequence":"additional","affiliation":[{"name":"Disease Elimination Program, Burnet Institute , Melbourne, Victoria ,","place":["Australia"]},{"name":"School of Public Health and Preventive Medicine, Monash University , Melbourne, Victoria ,","place":["Australia"]},{"name":"Department of Infectious Diseases, Alfred Health and Monash University , Melbourne, Victoria ,","place":["Australia"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2025,8,22]]},"reference":[{"key":"2025092508514043800_ofaf514-B1","doi-asserted-by":"crossref","first-page":"332","DOI":"10.1016\/S2468-1253(22)00386-7","article-title":"Global reporting of progress towards elimination of hepatitis B and hepatitis C","volume":"8","author":"Cui","year":"2023","journal-title":"Lancet Gastroenterol Hepatol"},{"key":"2025092508514043800_ofaf514-B2","doi-asserted-by":"crossref","first-page":"346","DOI":"10.1016\/S2468-1253(23)00321-7","article-title":"Progress towards elimination of viral hepatitis: a Lancet Gastroenterology & Hepatology Commission update","volume":"9","author":"Cooke","year":"2024","journal-title":"Lancet Gastroenterol Hepatol"},{"key":"2025092508514043800_ofaf514-B3","volume-title":"Australia's progress towards hepatitis C elimination: annual report 2023","author":"Burnet Institute and Kirby Institute","year":"2023"},{"key":"2025092508514043800_ofaf514-B4","volume-title":"HIV, viral hepatitis and sexually transmissible infections in Australia: annual surveillance report 2023","author":"King","year":"2023"},{"key":"2025092508514043800_ofaf514-B5","volume-title":"Monitoring hepatitis C treatment uptake in Australia (issue 13)","author":"Hajarizadeh","year":"2023"},{"key":"2025092508514043800_ofaf514-B6","doi-asserted-by":"crossref","first-page":"6","DOI":"10.1016\/S2468-1253(20)30366-6","article-title":"The phases of hepatitis C elimination: achieving WHO elimination targets","volume":"6","author":"Pedrana","year":"2021","journal-title":"Lancet Gastroenterol Hepatol"},{"key":"2025092508514043800_ofaf514-B7","doi-asserted-by":"crossref","first-page":"e0257369","DOI":"10.1371\/journal.pone.0257369","article-title":"Australia could miss the WHO hepatitis C virus elimination targets due to declining treatment uptake and ongoing burden of advanced liver disease complications","volume":"16","author":"Kwon","year":"2021","journal-title":"PLoS One"},{"key":"2025092508514043800_ofaf514-B8","doi-asserted-by":"crossref","first-page":"107","DOI":"10.1016\/j.drugpo.2017.07.006","article-title":"Reaching hepatitis C virus elimination targets requires health system interventions to enhance the care cascade","volume":"47","author":"Scott","year":"2017","journal-title":"Int J Drug Policy"},{"key":"2025092508514043800_ofaf514-B9","doi-asserted-by":"crossref","first-page":"426","DOI":"10.1016\/S2468-1253(21)00471-4","article-title":"Interventions to enhance testing, linkage to care, and treatment initiation for hepatitis C virus infection: a systematic review and meta-analysis","volume":"7","author":"Cunningham","year":"2022","journal-title":"Lancet Gastroenterol Hepatol"},{"key":"2025092508514043800_ofaf514-B10","volume-title":"Australian Recommendations for the management of hepatitis C virus infection: a consensus statement","author":"Hepatitis C Virus Infection Consensus Statement Working Group","year":"2022"},{"key":"2025092508514043800_ofaf514-B11","doi-asserted-by":"crossref","first-page":"253","DOI":"10.1016\/S2468-1253(22)00346-6","article-title":"Impact of hepatitis C virus point-of-care RNA viral load testing compared with laboratory-based testing on uptake of RNA testing and treatment, and turnaround times: a systematic review and meta-analysis","volume":"8","author":"Trickey","year":"2023","journal-title":"Lancet Gastroenterol Hepatol"},{"key":"2025092508514043800_ofaf514-B12","doi-asserted-by":"crossref","first-page":"100750","DOI":"10.1016\/j.lanwpc.2023.100750","article-title":"Optimizing point-of-care testing strategies for diagnosis and treatment of hepatitis C virus infection in Australia: a model-based cost-effectiveness analysis","volume":"36","author":"Shih","year":"2023","journal-title":"Lancet Reg Health\u2014Western Pacific"},{"key":"2025092508514043800_ofaf514-B13","doi-asserted-by":"crossref","first-page":"e0121450","DOI":"10.1371\/journal.pone.0121450","article-title":"Diagnostic accuracy of point-of-care tests for hepatitis C virus infection: a systematic review and meta-analysis","volume":"10","author":"Khuroo","year":"2015","journal-title":"PLoS One"},{"key":"2025092508514043800_ofaf514-B14","doi-asserted-by":"crossref","first-page":"1005","DOI":"10.1093\/infdis\/jiac049","article-title":"Diagnostic accuracy of assays using point-of-care testing or dried blood spot samples for the determination of hepatitis C virus RNA: a systematic review","volume":"226","author":"Catlett","year":"2022","journal-title":"J Infect Dis"},{"key":"2025092508514043800_ofaf514-B15","doi-asserted-by":"crossref","first-page":"103982","DOI":"10.1016\/j.drugpo.2023.103982","article-title":"Single-visit hepatitis C point-of-care testing, linkage to nursing care, and peer-supported treatment among people with recent injecting drug use at a peer-led needle and syringe program: the TEMPO Pilot Study","volume":"114","author":"Grebely","year":"2023","journal-title":"Int J Drug Policy"},{"key":"2025092508514043800_ofaf514-B16","doi-asserted-by":"crossref","first-page":"919","DOI":"10.1111\/jvh.13087","article-title":"Community-based, point-of-care hepatitis C testing: perspectives and preferences of people who inject drugs","volume":"26","author":"Latham","year":"2019","journal-title":"J Viral Hepat"},{"key":"2025092508514043800_ofaf514-B17","doi-asserted-by":"crossref","first-page":"e083502","DOI":"10.1136\/bmjopen-2023-083502","article-title":"Same-visit hepatitis C testing and treatment to accelerate cure among people who inject drugs (the QuickStart Study): a cluster randomised cross-over trial protocol","volume":"14","author":"Doyle","year":"2024","journal-title":"BMJ Open"},{"key":"2025092508514043800_ofaf514-B18","doi-asserted-by":"crossref","first-page":"e083502","DOI":"10.1136\/bmjopen-2023-083502","article-title":"Same-visit hepatitis C testing and treatment to accelerate cure among people who inject drugs (The QuickStart Study): a cluster randomised crossover trial (Study protocol)","volume":"14","author":"Doyle","year":"2024","journal-title":"BMJ Open"},{"key":"2025092508514043800_ofaf514-B19","author":"Australasian Society for HIV Viral Hepatitis and Sexual Health Medicine (ASHM)","year":"2022"},{"key":"2025092508514043800_ofaf514-B20","doi-asserted-by":"crossref","first-page":"e659","DOI":"10.1016\/S2214-109X(23)00057-8","article-title":"Epidemiology of injecting drug use, prevalence of injecting-related harm, and exposure to behavioural and environmental risks among people who inject drugs: a systematic review","volume":"11","author":"Degenhardt","year":"2023","journal-title":"Lancet Glob Health"},{"key":"2025092508514043800_ofaf514-B21","volume-title":"Australian drug trends 2022: key findings from the national Illicit Drug Reporting System (IDRS) interviews","author":"Sutherland","year":"2022"},{"key":"2025092508514043800_ofaf514-B22","volume-title":"Australian needle syringe program survey national data report 2018\u20132022: prevalence of HIV, HCV and injecting and sexual behaviour among NSP attendees","author":"Heard","year":"2023"},{"key":"2025092508514043800_ofaf514-B23","doi-asserted-by":"crossref","first-page":"204","DOI":"10.1016\/S2468-1253(22)00355-7","article-title":"A national programme to scale-up decentralised hepatitis C point-of-care testing and treatment in Australia","volume":"8","author":"Grebely","year":"2023","journal-title":"Lancet Gastroenterol Hepatol"},{"key":"2025092508514043800_ofaf514-B24","doi-asserted-by":"crossref","first-page":"421","DOI":"10.1177\/0272989X211045070","article-title":"Generating, presenting, and interpreting cost-effectiveness results in the context of uncertainty: a tutorial for deeper knowledge and better practice","volume":"42","author":"Bilcke","year":"2022","journal-title":"Med Decis Making"},{"key":"2025092508514043800_ofaf514-B25","doi-asserted-by":"crossref","first-page":"41","DOI":"10.1186\/s12962-024-00552-1","article-title":"An overview of the perspectives used in health economic evaluations","volume":"22","author":"Sittimart","year":"2024","journal-title":"Cost Eff Resour Alloc"},{"key":"2025092508514043800_ofaf514-B26","doi-asserted-by":"crossref","first-page":"23","DOI":"10.1186\/s12916-021-02204-0","article-title":"Consolidated Health Economic Evaluation Reporting Standards 2022 (CHEERS 2022) statement: updated reporting guidance for health economic evaluations","volume":"20","author":"Husereau","year":"2022","journal-title":"BMC Med"},{"key":"2025092508514043800_ofaf514-B27","doi-asserted-by":"crossref","first-page":"355","DOI":"10.2165\/00019053-200624040-00006","article-title":"Good practice guidelines for decision-analytic modelling in health technology assessment","volume":"24","author":"Philips","year":"2006","journal-title":"PharmacoEconomics"},{"key":"2025092508514043800_ofaf514-B28","volume-title":"R: a language and environment for statistical computing","author":"R Core Team","year":"2021"},{"key":"2025092508514043800_ofaf514-B29","author":"World Health Organization","year":"2017"},{"key":"2025092508514043800_ofaf514-B30","author":"World Health Organization","year":"2022"},{"key":"2025092508514043800_ofaf514-B31","doi-asserted-by":"crossref","first-page":"102837","DOI":"10.1016\/j.drugpo.2020.102837","article-title":"Estimating the consensus hepatitis C cascade of care among people who inject drugs in Australia: pre and post availability of direct acting antiviral therapy","volume":"83","author":"Iversen","year":"2020","journal-title":"Int J Drug Policy"},{"key":"2025092508514043800_ofaf514-B32","doi-asserted-by":"crossref","first-page":"375","DOI":"10.1111\/jvh.13664","article-title":"The impact of point-of-care hepatitis C testing in needle and syringe exchange programs on linkage to care and treatment uptake among people who inject drugs: an Australian pilot study","volume":"29","author":"Howell","year":"2022","journal-title":"J Viral Hepat"},{"key":"2025092508514043800_ofaf514-B33","doi-asserted-by":"crossref","first-page":"250","DOI":"10.1111\/jvh.13791","article-title":"Hepatitis C care cascade before and during the direct-acting antiviral eras in New South Wales, Australia: a population-based linkage study","volume":"30","author":"Yousafzai","year":"2023","journal-title":"J Viral Hepat"},{"key":"2025092508514043800_ofaf514-B34","author":"OECD","year":"2024"},{"key":"2025092508514043800_ofaf514-B35","author":"Australian Bureau of Statistics","year":"2024"},{"key":"2025092508514043800_ofaf514-B36","doi-asserted-by":"crossref","first-page":"2950","DOI":"10.1111\/liv.14628","article-title":"Cost-effectiveness of strategies to improve HCV screening, linkage-to-care and treatment in remand prison settings in England","volume":"40","author":"Mohamed","year":"2020","journal-title":"Liver Int"},{"key":"2025092508514043800_ofaf514-B37","author":"Australian Government Department of Health and Aged Care","year":"2024"},{"key":"2025092508514043800_ofaf514-B38","doi-asserted-by":"crossref","first-page":"549","DOI":"10.1007\/s40121-024-00926-1","article-title":"Direct-acting antivirals remain cost-effective treatments for chronic hepatitis C in Australia despite changes to the treated population and the availability of retreatment: the glecaprevir\/pibrentasvir (Maviret\u00ae) example","volume":"13","author":"Warren","year":"2024","journal-title":"Infect Dis Ther"},{"key":"2025092508514043800_ofaf514-B39","first-page":"100316","article-title":"Assessment of the cost-effectiveness of Australia's risk-sharing agreement for direct-acting antiviral treatments for hepatitis C: a modelling study","volume":"18","author":"Scott","year":"2022","journal-title":"Lancet Reg Health West Pac"},{"key":"2025092508514043800_ofaf514-B40","author":"Devleesschauwer","year":"2022"},{"key":"2025092508514043800_ofaf514-B41","author":"The Kirby Institute","year":"2024"},{"key":"2025092508514043800_ofaf514-B42","doi-asserted-by":"crossref","first-page":"100001","DOI":"10.1016\/j.jve.2020.06.001","article-title":"Price of a hepatitis C cure: cost of production and current prices for direct-acting antivirals in 50 countries","volume":"6","author":"Barber","year":"2020","journal-title":"J Virus Erad"},{"key":"2025092508514043800_ofaf514-B43","first-page":"97","article-title":"HCV reflex testing: a single-sample, low-contamination method that improves the diagnostic efficiency of HCV testing among patients in Alberta, Canada","volume":"7","author":"Thompson","year":"2022","journal-title":"J Assoc Med Microbiol Infect Dis Can"},{"key":"2025092508514043800_ofaf514-B44","volume-title":"Sixth National Hepatitis C Strategy 2023\u20132030 (consultation version)","author":"Department of Health and Aged Care","year":"2023"},{"key":"2025092508514043800_ofaf514-B45","author":"The Royal College of Pathologists of Australia","year":"2022"},{"key":"2025092508514043800_ofaf514-B46","doi-asserted-by":"crossref","first-page":"91","DOI":"10.1016\/j.drugpo.2019.05.012","article-title":"Point-of-care hepatitis C testing from needle and syringe programs: an Australian feasibility study","volume":"72","author":"Williams","year":"2019","journal-title":"Int J Drug Policy"},{"key":"2025092508514043800_ofaf514-B47","doi-asserted-by":"crossref","first-page":"965","DOI":"10.1093\/cid\/ciae155","article-title":"Point of care testing for hepatitis C in the priority settings of mental health, prisons and drug & alcohol facilities\u2014the PROMPt study","volume":"79","author":"McCartney","year":"2024","journal-title":"Clin Infect Dis"},{"key":"2025092508514043800_ofaf514-B48","doi-asserted-by":"crossref","first-page":"307","DOI":"10.1016\/S2468-1253(21)00397-6","article-title":"A minimal monitoring approach for the treatment of hepatitis C virus infection (ACTG A5360 [MINMON]): a phase 4, open-label, single-arm trial","volume":"7","author":"Solomon","year":"2022","journal-title":"Lancet Gastroenterol Hepatol"},{"key":"2025092508514043800_ofaf514-B49","doi-asserted-by":"crossref","first-page":"787","DOI":"10.1111\/liv.15123","article-title":"Cost-effectiveness analysis of hepatitis C virus (HCV) point-of-care assay for HCV screening","volume":"42","author":"Koo","year":"2022","journal-title":"Liver Int"},{"key":"2025092508514043800_ofaf514-B50","doi-asserted-by":"crossref","first-page":"102613","DOI":"10.1016\/j.drugpo.2019.102613","article-title":"Model-based cost-effectiveness estimates of testing strategies for diagnosing hepatitis C virus infection in people who use injecting drugs in Senegal","volume":"75","author":"Duchesne","year":"2020","journal-title":"Int J Drug Policy"},{"key":"2025092508514043800_ofaf514-B51","doi-asserted-by":"crossref","first-page":"104317","DOI":"10.1016\/j.drugpo.2024.104317","article-title":"Point-of-care HCV RNA testing improves hepatitis C testing rates and allows rapid treatment initiation among people who inject drugs attending a medically supervised injecting facility","volume":"125","author":"MacIsaac","year":"2024","journal-title":"Int J Drug Policy"},{"key":"2025092508514043800_ofaf514-B52","doi-asserted-by":"crossref","first-page":"830","DOI":"10.3390\/v11090830","article-title":"Hepatitis C core-antigen testing from dried blood spots","volume":"11","author":"Biondi","year":"2019","journal-title":"Viruses"},{"key":"2025092508514043800_ofaf514-B53","author":"Department of Health and Aged Care","year":"2024"}],"container-title":["Open Forum Infectious Diseases"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/academic.oup.com\/ofid\/advance-article-pdf\/doi\/10.1093\/ofid\/ofaf514\/64105633\/ofaf514.pdf","content-type":"application\/pdf","content-version":"am","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/ofid\/article-pdf\/12\/9\/ofaf514\/64105633\/ofaf514.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/ofid\/article-pdf\/12\/9\/ofaf514\/64105633\/ofaf514.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,9,25]],"date-time":"2025-09-25T12:52:01Z","timestamp":1758804721000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/ofid\/article\/doi\/10.1093\/ofid\/ofaf514\/8239546"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,8,22]]},"references-count":53,"journal-issue":{"issue":"9","published-print":{"date-parts":[[2025,8,29]]}},"URL":"https:\/\/doi.org\/10.1093\/ofid\/ofaf514","relation":{},"ISSN":["2328-8957"],"issn-type":[{"value":"2328-8957","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2025,9]]},"published":{"date-parts":[[2025,8,22]]},"article-number":"ofaf514"}}