OBJECTIVES: The overall prevalence of hepatitis C (HCV) among injection drug users (IDUs) in the United States is estimated at about 53%. Harm-reduction strategies like syringe service programs (SSP) and medications for opioid use disorder (MOUD) are effective in reducing HCV acquisition risk, and a combination of both provides an additive effect. This research aims to evaluate the cost-effectiveness of SSP alone, MOUD alone, and SSP+MOUD combination in preventing HCV cases among opioid IDUs in the United States.

METHODS: Using a decision-tree analytic model, we assessed cost-effectiveness from a public payer perspective over a one-year time horizon and considered both direct medical and non-medical costs associated with engaging in injection-risk behaviors. Cost-effectiveness was expressed as the incremental cost savings per HCV case avoided per 100 opioid IDUs compared to “no intervention” and incremental cost effectiveness ratio (ICER).

RESULTS: In the base case analysis, SSP+MOUD combination was the most effective intervention as it avoided 72 HCV cases among 100 opioid IDUs while SSP alone was the least expensive as it cost $5,518,130 for 100 opioid IDUs. The ICER for the combined strategy was $4,699 compared to SSP group. The incremental cost savings per HCV case avoided per 100 opioid IDUs compared to “no intervention” were as follows: SSP+MOUD combination = $347,573; SSP alone = $363,821; MOUD alone= $317,428. Sensitivity analysis showed that the results of the base case analysis were sensitive to variations in the probabilities of injection-risk behavior for the SSP and SSP+MOUD combination groups, probability of “NO HCV” with “no intervention”, and costs of MOUD and HCV antiviral.

CONCLUSIONS: Compared to “no intervention”, SSP and MOUD alone and in combination are more cost-effective and cost-saving harm reduction strategies. Nonetheless, the benefits of these harm reduction strategies will become more evident well beyond the one-year time horizon.