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Increased HCV treatment for PWID in UK prisons cost-effective
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Using a model of incarcerated individuals and hepatitis C virus infection transmission among people who inject drugs in England, researchers found that increased treatment and shorter duration direct-acting antiviral therapy may be more cost-effective compared with case-finding and current treatment methods.
“Our model shows that baseline or existing levels of HCV treatment for [people who inject drugs (PWID)] in prison and the community are unlikely to result in observable changes in chronic HCV prevalence or incidence among PWID in prison in the next 50 years,” Natasha K. Martin, DPhil, associate professor in the division of global public health, University of California, San Diego, and colleagues wrote in Hepatology.
Martin and colleagues developed a model that measured the cost-effectiveness of doubling HCV case-finding — achieved through the use of opt-out testing — and increasing treatment in U.K. prisons, and then compared it with status quo voluntary risk-based testing. The two approaches were compared using either currently recommended therapies (8-24 weeks) or interferon (IFN)-free direct-acting antivirals (DAAs; 8-12 weeks).
The researchers used costs (British pounds) and quality-adjusted life years (QALY) to calculate mean incremental cost-effectiveness ratios (ICERs).
“We assumed 56% referral and 2.5% of 25% of referred PWID or ex-PWID were treated within 2 months of diagnosis in prison,” the researchers wrote. “PWID and ex-PWID or non-PWID are in prison an average of 4 and 8 months, respectively.”
Overall, the model showed that doubling prison HCV testing rates with existing treatments had a mean ICER of 19,850 pounds per QALY gained compared with current testing or treatment. This indicated that this method is 45% likely to be cost-effective under a 20,000 pounds’ willingness-to-pay threshold, according to the study. Switching to an 8- to 12-week IFN-free DAA regimen in prisons may increase cost-effectiveness (ICER: 15,090 pounds per QALY gained). Excluding prevention benefit decreases this cost-effectiveness, the researchers said.
In addition, if more than 10% of prisoners who are referred PWID are treated in prison, either treatment could be highly cost-effective (ICER: less than 13,000 pounds). HCV case-finding and IFN-free DAAs could be highly cost-effective if DAA cost is 10% lower or with 8 weeks’ duration.
“Increased HCV testing in U.K. prisons is borderline cost-effective compared to status quo voluntary risk-based testing under a 20,000 [pounds’] willingness to pay with current treatments, but likely to be cost-effective if short-course IFN-free DAAs are used and could be highly cost-effective if PWID treatment rates were increased,” Martin and colleagues concluded. – by Melinda Stevens
- Reference:
- Martin NK, et al. Hepatology. 2016;doi:10.1002/hep.28497.
Disclosure: Martin reports receiving grants from Gilead Sciences and honoraria from AbbVie, Merck and Janssen. Please see the full study for a list of all other authors’ relevant financial disclosures.