International Journal of Drug Policy 22 (2011) 70–76 Contents lists available at ScienceDirect International Journal of Drug Policy journal homepage: www.elsevier.com/locate/drugpo Research paper Treatment costs of hepatitis C infection among injection drug users in Canada, 2006–2026 Daniel Werb a , Evan Wood a , Thomas Kerr a,b , Neil Hershfield d , Robert W.H. Palmer d , Robert S. Remis c,* a British Columbia Centre for Excellence in HIV/AIDS, St. Paul’s Hospital, Vancouver, British Columbia, Canada b Division of AIDS, University of British Columbia, Vancouver, British Columbia, Canada c Dalla Lana School of Public Health, University of Toronto, 155 College Avenue, Room 512, Toronto, Ontario, Canada M5T 3M7 d Dalla Lana School of Public Health, University of Toronto, Canada article info Article history: Received 30 October 2009 Received in revised form 21 June 2010 Accepted 20 September 2010 Keywords: Hepatitis C Injection drug use Treatment Costs Canada abstract Background: Canadian injection drug users (IDUs) are at high risk of hepatitis C virus infection (HCV). How- ever, little is known about the costs associated with their HCV-related medical treatment. We estimated the medical costs of treating HCV-infected IDUs from 2006 to 2026. Methods: We employed a Markov model of entry through birth or immigration to exposure-related behaviours or experiences, HCV infection, progression to HCV sequelae and mortality for active and ex-IDUs in Canada. We estimated direct and indirect treatment costs using data from the Ontario Case Costing Initiative (OCCI). Result: Approximately 137,000 IDUs will suffer from HCV-related disease each year until 2026. Applying the OCCI cost data to the prevalence of HCV-related disease from 2006 to 2026 yielded an estimated cost of $3.96 billion CND to treat HCV-infected IDUs. Conclusions: Substantial costs are associated with the treatment of HCV-related disease among Canadian IDUs. Given the lack of effective HCV prevention strategies in Canada, we must develop targeted evidence- based responses to prevent HCV transmission and ensure appropriate allocation of medical resources to meet the present and future treatment needs of HCV-infected IDUs. © 2010 Elsevier B.V. All rights reserved. Introduction Since its identification in 1989, hepatitis C has been implicated in substantial morbidity and mortality among vulnerable popula- tions worldwide (Alter, Conry-Cantilena, & Melpolder, 1997; Wu, Wu, & Wong, 2006; Zou, El Saadany, Forrester & Giulivi, 2001). Hep- atitis C virus (HCV) is approximately 10–15 times more infectious than HIV and populations vulnerable to blood-borne infection are often highly susceptible to HCV infection (Heintges & Wands, 1997; Liddle, 1996; Mather & Crofts, 1999). An estimated 170 million peo- ple, or 3% of the global population, are infected with the hepatitis C virus (HCV) (World Health Organization [WHO], 2002). Prior to the development of a blood test to detect HCV, blood transfusion was an important source of infection (Remis, Hogg, Krahn, Preiksaitis, & Sherman, 1998a). However, with current sensitive screening assays, the risk of HCV infection through blood transfusion has become negligible in North America (Schreiber, Busch, Kleinman & Korelitz, 1996), though the risk of HCV infection through injection * Corresponding author. Tel.: +1 416 946 3250; fax: +1 416 978 8299. E-mail address: rs.remis@utoronto.ca (R.S. Remis). drug use remains high. Among Vancouver’s injecting drug users (IDUs), scientists have observed HCV incidence rates of up to 37 per 100 person-years (Miller, Johnston, & Spittal, 2002; Patrick, Tyndall, & Cornelisse, 2001; Strathdee, Patrick, & Currie, 1997) and HCV prevalence as high as 95% (Hagan, 1998). However, despite a large body of epidemiologic and clinical research characterising the determinants and extent of the HCV epidemic among IDU pop- ulations, as well as the costly outcomes related to the treatment of HCV sequelae, policy makers in Canada have not given high priority to dealing with HCV infection in this vulnerable population. An estimated 70% of IDUs in Canada are believed to be infected with HCV (Wiebe, 2000), however, it is only since 2000 that antiviral treatment of HCV-infected IDUs has been recommended in Canada (Sherman et al., 2004). The costs of the treatment of later-stage HCV-related disease, including liver transplants, are expected to rise (Saadany, Coyle, Giulivi & Afal, 2005). While HCV infection in Canada can properly be termed a health crisis, future health care costs have not been systematically examined. This has pre- cluded a discussion of necessary resource allocation and of the cost-effectiveness of different HCV prevention strategies. We there- fore sought to determine the potential costs related to treatment of HCV-related disease in Canada among IDUs from 2006 to 2026. 0955-3959/$ – see front matter © 2010 Elsevier B.V. All rights reserved. doi:10.1016/j.drugpo.2010.09.006