Scaling up HCV testing, treatment in prisons highly cost-effective
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Key takeaways:
- The risk for HCV infection in correctional settings is disproportionately higher than other settings.
- Scaling up HCV testing and treatment in prisons effectively reduced HCV incidence and was cost-effective.
Scaling up hepatitis C testing and treatment in prisons effectively reduced HCV incidence and was a cost-effective option compared with existing services, data from a study in Australian prisons showed.
“There is a disproportionately high HCV prevalence in people who inject drugs in correctional settings, estimated at 15% of the 10 million people who are incarcerated at any one time worldwide,” Sophy T.F. Shih, DrPH, a senior health economist at the Kirby Institute of University of New South Wales, and colleagues wrote. “The Surveillance and Treatment of Prisoners with hepatitis C (SToP-C) study, a nonrandomized clinical trial within a longitudinal cohort of 3,691 prisoners, evaluated the impact of [direct-acting antiviral agent (DAA)] treatment on HCV incidence in four prisons located in Australia’s most populous state, New South Wales.”
In the first phase of SToP-C, HCV treatment was delivered as the standard of care by the nurse-led prison-based hepatitis service. In the second phase, the team initiated an “intensive scale-up” of testing and DAA treatment by increasing the capacity of prison health services with dedicated nurses to deliver HCV treatment and prison officers to facilitate prisoner movement.
Overall, the outcomes of both phases demonstrated that rapid HCV treatment scale-up in prisons reduced HCV transmission (adjusted HR = 0.5; 95% CI, 0.33-0.76).
In the most recent study using SToP-C data, Shih and colleagues used SToP-C and Australian costing data to estimate the cost-effectiveness of scaling-up HCV treatment in prisons by 44% — which was achieved by the SToP-C study — for 10 years before reducing to baseline levels and compared these results with a status-quo scenario.
Overall, the estimates demonstrated that scaling up HCV treatment in a statewide prison service is projected to be cost-effective, with an average incremental cost-effectiveness ratio (ICER) of $12,968 in Australian currency per quality-adjust life-year (QALY) gained. According to the study, a base-case scenario showed 275 QALY gained over 40 years with a net incremental cost of $3.6 million. After excluding DAA pharmaceutical costs, the mean ICER was reduced to $6,054 per QALY.
Based on these findings, the authors wrote that scaling up HCV testing and treatment in prisons is not only effective in reducing HCV incidence but also cost-effective.
“The scale-up of HCV treatment efforts and resource should be considered a priority in the national elimination strategy,” the concluded.
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Shih STF, et al. Open Forum Infect Dis. 2023;doi:10.1093/ofid/ofad637.
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