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

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

doi:10.1371/journal.pone.0245896

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.

Highlights

200,000 Australians have hepatitis C infection, a leading cause of liver-related deaths, with around 400 deaths per 100,000 population are attributed to hepatitis C virus (HCV) infection in 2015 [1, 2]
The prevalence of chronic HCV was lowest with 36 months lengths of stay (LOS), because the lower number of people coming into the population corresponds to a reduced incidence rate (Table 1)
Except for the 2 months LOS, from 50% direct-acting antiviral (DAA) coverage, increasing LOS did not play a major role in reducing the prevalence of HCV, but increases in treatment coverage reduced the prevalence of HCV

Summary

Introduction

200,000 Australians have hepatitis C infection, a leading cause of liver-related deaths, with around 400 deaths per 100,000 population are attributed to hepatitis C virus (HCV) infection in 2015 [1, 2]. The risk of acquiring infectious disease in the prison setting is higher than in the general population including high rates of exposure to blood-borne viral infections such as HCV. The development of direct-acting antiviral (DAA) therapy for HCV provides a safe and highly effective cure rate of over 95% [4,5,6,7,8]. In March 2016, the Australian government provided highly subsidized access to DAA therapy for people living with HCV, without restrictions on liver disease stage, drug and alcohol use, or prescriber type, with specific inclusion of access for prisoners [9]

Methods

Results

Conclusion