Co-located hepatitis C treatment at syringe service programs (SSP) is an emerging model of low-threshold care delivery for people who inject drugs (PWID). Economic data regarding this innovative treatment model has not been reported from the United States.
We conducted an economic evaluation of an "Accessible Care" intervention that provided hepatitis C treatment at a SSP in New York City, alongside a randomized clinical trial testing the effectiveness of this model. Intervention start-up, time-dependent, and variable costs were determined from the program's perspective using a micro-costing approach. We applied nationally representative estimates for laboratory unit costs and local wage rates. Results are reported in 2020 US dollars.
The care model employed one physician and one care coordinator operating in a clinical office located at an SSP. All participants were offered hepatitis C clinical evaluation and treatment, a reinfection prevention education session, and additional care coordination on an as-needed basis. The intervention ran for 42 months, enrolled 84 HCV RNA-positive PWID, of which 64 initiated treatment. Start-up costs including training and equipment totaled $4,723. Time-dependent costs including rent, utilities and software fees totaled $2,229 per month. The per-participant variable cost of intervention was $3,122, of which $376 was physician time, $2,232 was care coordinator time, and $514 was laboratory cost, including phlebotomy. The total program cost was $3,402 per enrolled participant and $4,466 per treated participant.
The estimated costs reported here can provide insight to other US-based clinical providers seeking to provide co-located hepatitis C care at syringe service programs. Care coordination costs may require financing strategies beyond insurance reimbursement in order to be sustained.