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Simulation: Universal prison-based screening reduces HCV transmission

In a new study, researchers found through a computer simulation model that universal screening for hepatitis C virus infection among prisons is cost-effective and could reduce transmission of the infection, as well as HCV-associated liver disease, according to published findings.

“Our model is the first of its kind to capture the indirect, society-wide benefits of HCV control interventions in prisons,” Tianhua He, MD, School of Medicine, Tsinghua University Medical School, Beijing, China, said in a press release. “We expect this new approach to measuring the impact of medical interventions on HCV in the wider community may also be applied to future studies of other infectious diseases.”

He and colleagues, including Jagpreet Chhatwal, PhD, assistant professor of Radiology at Harvard Medical School, and decision scientist at Massachusetts General Hospital Institute for Technology Assessment, developed an agent-based microsimulation model that projected long-term outcomes, such as the benefits and costs, of various HCV screening and treatment scenarios implemented in prisons. The model evaluated five screening strategies, which included no screening, one-time screenings of current and new inmates with a history of injection drug use for 1 year (1Yr-Risk) and one-time universal opt-out screenings of all current and new inmates for 1 year (1Yr-All), 5 years (5Yr-All) and 10 years (10Yr-All), according to the research.

Jagpreet Chhatwal

The release stated that the simulation model incorporated various dynamics of HCV among inmates and the general population, including factors such as the progression of HCV, transmission and the movement of inmates in and out of prisons. In addition, the model projected the costs involved with screening and treating inmates and the benefits.

Analyses of the simulation showed that the 1Yr-Risk method would diagnose 41,900 new cases of HCV over the next 30 years compared with the 1Yr-All (81,100), 5Yr-All (106,600) and 10Yr-All (122,700) methods. Of the three All scenarios, 70,700 of the new HCV cases diagnosed over these time periods would be among current inmates. The cost of screening per HCV case would be $880 using the 1Yr-Risk method, $1,300 using 1Yr-All, $1,680 using 5Yr-All and $2,030 using 10Yr-All methods.

When compared to the no screening method, the other four methods would prevent more new HCV cases (1Yr-Risk: 5,500; 1Yr-All: 8,000; 5Yr-All: 10,900; and 10Yr-All: 12,700) over the next 30 years. Of the preventable cases, 89% to 92% would occur in the general population, according to the research.

“In addition to reducing the transmission of HCV after prisoners are released, universal HCV testing and treatment in prisons would reduce outcomes of advanced HCV — such as liver cancer, end-stage liver disease and death — among prisoners,” Chhatwal said in the release. “We now have highly effective treatments for HCV, so we wanted to know the impact of providing routine testing and treatment to inmates, a group in which the infection is highly prevalent.”

The 1Yr-Risk method would reduce HCV disease cost due to in-prison treatment programs by $260 million, compared with $510 million using the 1Yr-All method, $680 million using the 5Yr-All method and $760 million using the 10Yr-All method.

The researchers concluded: “Screening the incarcerated population would play an important role in reducing HCV burden society-wide. Therefore, HCV prevention efforts should have an increased focus on prison inmates.”

“From a societal perspective, investing in U.S. prison health care to manage hepatitis C would be money well spent.” – by Melinda Stevens

Disclosures: The researchers report no relevant financial disclosures.