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Informing the Equitable Implementation of Hepatitis C Interventions: Cost-Effectiveness Modeling in Rural Populations
Sheri A Tubach1, François M Castonguay2
1School of Public Health, University of Illinois Chicago, Chicago, IL, 60612, USA. stubac2@uic.edu.
Pharmacoeconomics
|June 4, 2026
Summary
Scaling up hepatitis C virus (HCV) testing and treatment is highly cost-effective for rural populations. Adding syringe services programs further reduces HCV incidence and advances health equity.
Area of Science:
- Public Health
- Health Economics
- Infectious Disease Epidemiology
Background:
- Rural settings face significant hepatitis C virus (HCV) burden among persons who inject drugs (PWID) due to structural barriers and limited resources.
- Disparities in HCV prevalence and access to care are pronounced in these underserved communities.
Purpose of the Study:
- To evaluate the cost-effectiveness of evidence-based interventions for HCV prevention and treatment among PWID in rural areas.
- To inform equitable implementation planning and resource allocation for HCV elimination efforts.
Main Methods:
- An economic-epidemiological model was developed to simulate HCV transmission dynamics over a 20-year period.
- The model assessed the cost-effectiveness of various interventions, including testing, treatment, harm reduction (syringe services programs - SSPs), and medication-assisted treatment (MAT), using metrics like DALYs averted.
Main Results:
- Expanding HCV testing and treatment demonstrated high cost-effectiveness (US$1139/DALY averted), projected to reduce HCV incidence by 90% within 10 years.
- Integrating SSPs (25% coverage) further accelerated incidence reduction and remained cost-effective (US$2116/DALY averted).
- Comprehensive strategies combining expanded testing, treatment, SSPs, and MAT averted the most infections and achieved rapid incidence reduction, albeit at a higher cost per DALY averted.
Conclusions:
- Scaling up HCV testing and treatment is a highly cost-effective strategy for rural communities.
- Adding SSPs enhances intervention value and supports policy decisions to reduce disparities in areas with limited harm reduction infrastructure.
- Investment in comprehensive, community-centered interventions is crucial for achieving health equity in HCV elimination.
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