Cost-effectiveness of HCV case-finding for people who inject drugs via dried blood spot testing in specialist addiction services and prisons

Martin, Natasha K.; Hickman, Matthew; Miners, Alec; Hutchinson, Sharon J.; Taylor, Avril; Vickerman, Peter

doi:10.1136/bmjopen-2013-003153

Cited by 76 publications

(97 citation statements)

References 46 publications

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“…We adapt a dynamic model of incarceration and HCV transmission among PWID in England (3, 4). Full details of the model structure and calibration can be found in previous publications (3, 4) and the supplementary information.…”

Section: Methodsmentioning

confidence: 99%

Is increased hepatitis C virus case‐finding combined with current or 8‐week to 12‐week direct‐acting antiviral therapy cost‐effective in UK prisons? A prevention benefit analysis

et al. 2016

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Background Prisoners have a high prevalence of Hepatitis C virus (HCV), but case-finding may not have been cost-effective because treatment often exceeded average prison stay combined with a lack of continuity-of-care. We assess the cost-effectiveness of increased HCV case-finding and treatment in UK prisons using short-course therapies. Methods A dynamic HCV transmission model assesses the cost-effectiveness of doubling HCV case-finding (achieved through introducing opt-out HCV testing in UK pilot prisons) and increasing treatment in UK prisons, compared to status-quo voluntary risk-based testing (6% prison entrants/year), using currently recommended therapies (8–24 weeks) or IFN-free DAAs (8–12 weeks, 95% SVR, £3300/wk). Costs (GBP£) and health utilities (quality-adjusted life-years, QALYs) were used to calculate mean incremental cost-effectiveness ratios (ICERs). We assume 56% referral and 2.5%/25% of referred people who inject drugs (PWID)/exPWID treated within 2 months of diagnosis in prison. PWID and ex/nonPWID are in prison an average 4/8 months, respectively. Results Doubling prison testing rates with existing treatments produces a mean ICER of £19,850/QALY gained compared to current testing/treatment, and is 45% likely to be cost-effective under a £20,000 willingness-to-pay (WTP) threshold. Switching to 8–12 week IFN-free DAAs in prisons could increase cost-effectiveness (ICER £15,090/QALY gained). Excluding prevention benefit decreases cost-effectiveness. If >10% referred PWID are treated in prison (2.5% base-case), either treatment could be highly cost-effective (ICER<£13,000). HCV case-finding and IFN-free DAAs could be highly cost-effective if DAA cost is 10% lower or 8 weeks duration. Conclusions Increased HCV testing in UK prisons (such as through opt-out testing) is borderline cost-effective compared to status-quo voluntary risk-based testing under a £20,000 WTP 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.

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Section: Methodsmentioning

confidence: 99%

Is increased hepatitis C virus case‐finding combined with current or 8‐week to 12‐week direct‐acting antiviral therapy cost‐effective in UK prisons? A prevention benefit analysis

et al. 2016

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“…Focused testing has been shown to be costeffective in most higher risk populations and settings [43,48,55,56,[58][59][60][61][64][65][66]71] and has a high yield of case finding. In addition, the higher the treatment rates, the greater the population impact, and the more cost-effective HCV case finding becomes [72].…”

Section: Recommendation and Rationale On Testing Approachesmentioning

confidence: 99%

Who to test and how to test for chronic hepatitis C infection – 2016 WHO testing guidance for low- and middle-income countries

Easterbrook

2016

Journal of Hepatology

115

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“…Injection drug use (IDU) is the most common mode of HCV transmission, and 20%–55% of inmates have a history of IDU (8, 9). If infected releasees take up IDU upon return, they could contribute to HCV spread in society (10, 11). The US Preventive Services Task Force recommends that a history of incarceration should trigger HCV testing (12).…”

Section: Introductionmentioning

confidence: 99%

Prevention of Hepatitis C by Screening and Treatment in U.S. Prisons

He¹,

Li²,

Roberts³

et al. 2015

Ann Intern Med

143

169

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Background The prevalence of hepatitis C virus (HCV) in United States prisoners is high; however, HCV testing and treatment is rare. Infected inmates released back into society contribute to the spread of HCV in the general population. Routine hepatitis screening of inmates followed by treatment with new therapies offers hope to reduce ongoing HCV transmission. Objective To evaluate the health and economic impact of HCV screening and treatment in prisons on the HCV epidemic in the society. Design An agent-based microsimulation model of transmission and progression of HCV. Data Sources Published literature. Target population Population in US prisons and general community. Time horizon 30 years. Perspective Societal. Interventions Risk-based and universal opt-out hepatitis C screening in prisons followed by treatment in a portion of patients. Outcome measures Prevention of HCV transmission and associated-disease in prisons and society, costs, quality-adjusted life years (QALYs), incremental cost-effectiveness ratio (ICER), and total prison budget. Results of Base-Case Analysis Implementing risk-based and opt-out screening could diagnose 41 900–122 700 new HCV cases in the next 30 years in prisons. Compared with no screening, these scenarios could prevent 5500–12 700 new HCV infections caused by releasees, where about 90% of averted infections would have occurred outside of prisons. HCV screening could also prevent 4200–11 700 liver-related deaths. The ICERs of screening scenarios were between $19 600–$29 200/QALY, and the respective 1st year prison budget were between $900 and $1150 million. Prisons would require an additional 12.4% of their current healthcare budget to implement such interventions. Results of Sensitivity Analysis Results were sensitive to the time horizon; and ICERs otherwise remained below $50 000 per QALY. Limitations Data on transmission network, re-infection rate and opt-out HCV screening rate are lacking. Conclusions Universal opt-out HCV screening in prisons is highly cost-effective and would reduce HCV transmission and HCV-associated diseases primarily in the outside community. Investing in US prisons to manage hepatitis C is a strategic approach to address the current epidemic.

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Cost-effectiveness of HCV case-finding for people who inject drugs via dried blood spot testing in specialist addiction services and prisons

Cited by 76 publications

References 46 publications

Is increased hepatitis C virus case‐finding combined with current or 8‐week to 12‐week direct‐acting antiviral therapy cost‐effective in UK prisons? A prevention benefit analysis

Is increased hepatitis C virus case‐finding combined with current or 8‐week to 12‐week direct‐acting antiviral therapy cost‐effective in UK prisons? A prevention benefit analysis

Who to test and how to test for chronic hepatitis C infection – 2016 WHO testing guidance for low- and middle-income countries

Prevention of Hepatitis C by Screening and Treatment in U.S. Prisons

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