Modelling the Impact and Cost-effectiveness of Extended Hepatitis C Virus Screening and Treatment with Direct-acting Antivirals in a Swiss Custodial Setting

Abstract

Background Hepatitis C virus (HCV) among people living in detention (PLD) is typically high in many countries including Switzerland, where it is estimated that the HCV prevalence rate is between 5.7% and 6.2%. In Switzerland, the existing screening strategy involves routine screening of PLD who indicate they are from HCV high-risk populations based on questionnaire responses upon entry to the detention center, rather than an offer to screen all PLD. Methods A cost-effectiveness analysis from a Swiss healthcare provider perspective was conducted by combining a 5-year decision tree screening model with results from a Markov model of HCV treatment outcomes. This model explored the cost-effectiveness of increased HCV screening to cover all PLD compared to the current approach, using a standard test package and subsequent treatment with a single-tablet regimen in Swiss custodial settings. Sensitivity and scenario analyses examined the uncertainty of results. Results At the willingness-to-pay threshold of 100 000 Swiss Francs (CHF) per quality-adjusted life-year (QALY), comprehensive general screening was cost-effective compared to current risk-based screening, with a base case incremental cost-effectiveness ratio of CHF 14 312 per QALY. The net monetary benefit of screening the whole PLD population was CHF 23 298 046 and CHF 4298 per person. The proportion of PLD tested was predicted to increase from 13.6% to 67.0% under comprehensive screening. Conclusion The results showed that comprehensive screening strategies in detention centers in Switzerland can be cost-effective, with the probabilistic sensitivity analysis estimating an 82.3% probability of cost-effectiveness.

Feasibility and efficacy of 8 week Glecaprevir/Pibrentasvir to treat incarcerated viraemic HCV patients: A case‐control study

“…This approach was demonstrated to be absolutely cost‐effective. A cost‐effectiveness analysis of extended HCV screening and treatment with DAAs in a Swiss custodial setting showed a clear monetary benefit 17 Similarly, an approach based on screening, treating all and linking to care at release was considered a good value with increased SVR rates and reduction of cirrhosis 18 …”

Increasing hepatitis C virus screening in people who inject drugs in Switzerland using rapid antibody saliva and dried blood spot testing: A cost‐effectiveness analysis

“…The cohort decision tree screening model was adapted from a previous model to simulate HCV screening of PWID in general practice in Switzerland . The eligible screening population was assumed to be the whole target population, irrespective of whether or not they had been diagnosed as HCV‐positive and were aware of their status or not, based on clinical expert opinion.…”

Hepatitis C prevalences in the psychiatric setting: Cost-effectiveness of scaling-up screening and direct-acting antiviral therapy

“…Model structure and perspective A previously published cohort decision tree screening model was adapted to analyse the cost-effectiveness of diagnosis and treatment, after scaling up HCV screening in PMI compared with current standard-of-care. 11,12 The decision tree simulated the patient pathway from screening to diagnosis and treatment initiation (Fig. 1).…”