Abstract
Background:
The Surveillance and Treatment of Prisoners With Hepatitis C (SToP-C) study demonstrated that scaling up of direct-acting antiviral (DAA) treatment reduced hepatitis C virus (HCV) transmission. We evaluated the cost-effectiveness of scaling up HCV treatment in statewide prison services incorporating long-term outcomes across custodial and community settings.
Methods:
A dynamic model of incarceration and HCV transmission among people who inject drugs (PWID) in New South Wales, Australia, was extended to include former PWID and those with long-term HCV progression. Using Australian costing data, we estimated the cost-effectiveness of scaling up HCV treatment in prisons by 44% (as achieved by the SToP-C study) for 10 years (2021–2030) before reducing to baseline levels, compared to a status quo scenario. The mean incremental cost-effectiveness ratio (ICER) was estimated by comparing the differences in costs and quality-adjusted life-years (QALYs) between the scale-up and status quo scenarios over 40 years (2021–2060) discounted at 5% per annum. Univariate and probabilistic sensitivity analyses were performed.
Results:
Scaling up HCV treatment in the statewide prison service is projected to be cost-effective with a mean ICER of A$12 968/QALY gained. The base-case scenario gains 275 QALYs over 40 years at a net incremental cost of A$3.6 million. Excluding DAA pharmaceutical costs, the mean ICER is reduced to A$6 054/QALY. At the willingness-to-pay threshold of A$50 000/QALY, 100% of simulations are cost-effective at various discount rates, time horizons, and changes of treatment levels in prison and community.
Conclusions:
Scaling up HCV testing and treatment in prisons is highly cost-effective and should be considered a priority in the national elimination strategy.
Clinical Trials Registration:
NCT02064049.
The Surveillance and Treatment of Prisoners With Hepatitis C (SToP-C) study demonstrated that scaling up of direct-acting antiviral (DAA) treatment reduced hepatitis C virus (HCV) transmission. We evaluated the cost-effectiveness of scaling up HCV treatment in statewide prison services incorporating long-term outcomes across custodial and community settings.
Methods:
A dynamic model of incarceration and HCV transmission among people who inject drugs (PWID) in New South Wales, Australia, was extended to include former PWID and those with long-term HCV progression. Using Australian costing data, we estimated the cost-effectiveness of scaling up HCV treatment in prisons by 44% (as achieved by the SToP-C study) for 10 years (2021–2030) before reducing to baseline levels, compared to a status quo scenario. The mean incremental cost-effectiveness ratio (ICER) was estimated by comparing the differences in costs and quality-adjusted life-years (QALYs) between the scale-up and status quo scenarios over 40 years (2021–2060) discounted at 5% per annum. Univariate and probabilistic sensitivity analyses were performed.
Results:
Scaling up HCV treatment in the statewide prison service is projected to be cost-effective with a mean ICER of A$12 968/QALY gained. The base-case scenario gains 275 QALYs over 40 years at a net incremental cost of A$3.6 million. Excluding DAA pharmaceutical costs, the mean ICER is reduced to A$6 054/QALY. At the willingness-to-pay threshold of A$50 000/QALY, 100% of simulations are cost-effective at various discount rates, time horizons, and changes of treatment levels in prison and community.
Conclusions:
Scaling up HCV testing and treatment in prisons is highly cost-effective and should be considered a priority in the national elimination strategy.
Clinical Trials Registration:
NCT02064049.
| Original language | English |
|---|---|
| Article number | ofad637 |
| Number of pages | 9 |
| Journal | Open Forum Infectious Diseases |
| Volume | 11 |
| Issue number | 2 |
| Early online date | 18 Dec 2023 |
| DOIs | |
| Publication status | Published - 9 Feb 2024 |
Bibliographical note
Funding Information:This work was supported by the National Health and Medical Research Council (Award number APP1092547) in partnership with Gilead Sciences. A. R. L. was supported by an National Health Medical Research Council Practitioner Fellowship (award number APP1137587). G. J. D. is funded by an National Health Medical Research Council Investigator Grant (grant number 2008276). J. S. and P. V. acknowledge funding from the Wellcome Trust (grant number 226619/Z/22/Z) and the National Institute for Health and Care Research Health Protection Research Unit in Behavioural Science and Evaluation at the University of Bristol.
Publisher Copyright:
© The Author(s) 2023.