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Hepatitis C treatment strategies in prisons: A cost-effectiveness analysis

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Listed:
  • Jisoo A Kwon
  • Georgina M Chambers
  • Fabio Luciani
  • Lei Zhang
  • Shamin Kinathil
  • Dennis Kim
  • Hla-Hla Thein
  • Willings Botha
  • Sandra Thompson
  • Andrew Lloyd
  • Lorraine Yap
  • Richard T Gray
  • Tony Butler

Abstract

In Australian prisons approximately 20% of inmates are chronically infected with hepatitis C virus (HCV), providing an important population for targeted treatment and prevention. A dynamic mathematical model of HCV transmission was used to assess the impact of increasing direct-acting antiviral (DAA) treatment uptake on HCV incidence and prevalence in the prisons in New South Wales, Australia, and to assess the cost-effectiveness of alternate treatment strategies. We developed four separate models reflecting different average prison lengths of stay (LOS) of 2, 6, 24, and 36 months. Each model considered four DAA treatment coverage scenarios of 10% (status-quo), 25%, 50%, and 90% over 2016–2045. For each model and scenario, we estimated the lifetime burden of disease, costs and changes in quality-adjusted life years (QALYs) in prison and in the community during 2016–2075. Costs and QALYs were discounted 3.5% annually and adjusted to 2015 Australian dollars. Compared to treating 10% of infected prisoners, increasing DAA coverage to 25%, 50%, and 90% reduced HCV incidence in prisons by 9–33% (2-months LOS), 26–65% (6-months LOS), 37–70% (24-months LOS), and 35–65% (36-months LOS). DAA treatment was highly cost-effective among all LOS models at conservative willingness-to-pay thresholds. DAA therapy became increasingly cost-effective with increasing coverage. Compared to 10% treatment coverage, the incremental cost per QALY ranged from $497-$569 (2-months LOS), -$280–$323 (6-months LOS), -$432–$426 (24-months LOS), and -$245–$477 (36-months LOS). Treating more than 25% of HCV-infected prisoners with DAA therapy is highly cost-effective. This study shows that treating HCV-infected prisoners is highly cost-effective and should be a government priority for the global HCV elimination effort.

Suggested Citation

  • Jisoo A Kwon & Georgina M Chambers & Fabio Luciani & Lei Zhang & Shamin Kinathil & Dennis Kim & Hla-Hla Thein & Willings Botha & Sandra Thompson & Andrew Lloyd & Lorraine Yap & Richard T Gray & Tony B, 2021. "Hepatitis C treatment strategies in prisons: A cost-effectiveness analysis," PLOS ONE, Public Library of Science, vol. 16(2), pages 1-13, February.
  • Handle: RePEc:plo:pone00:0245896
    DOI: 10.1371/journal.pone.0245896
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    References listed on IDEAS

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    1. Briggs, Andrew & Sculpher, Mark & Claxton, Karl, 2006. "Decision Modelling for Health Economic Evaluation," OUP Catalogue, Oxford University Press, number 9780198526629.
    2. Laura Catherine Edney & Hossein Haji Ali Afzali & Terence Chai Cheng & Jonathan Karnon, 2018. "Estimating the Reference Incremental Cost-Effectiveness Ratio for the Australian Health System," PharmacoEconomics, Springer, vol. 36(2), pages 239-252, February.
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