Natasha K Martin1,2, Peter Vickerman2, Iain F Brew3, Joan Williamson3, Alec Miners4, William L Irving5, Sushma Saksena6, Sharon J Hutchinson7, Sema Mandal8, Eamonn O'Moore8, Matthew Hickman2. 1. Division of Global Public Health, University of California San Diego, San Diego, CA. 2. School of Social and Community Medicine, University of Bristol, Bristol, UK. 3. Leeds Community Healthcare NHS Trust, Leeds, UK. 4. London School of Hygiene and Tropical Medicine, London, UK. 5. University of Nottingham, Nottingham, UK. 6. County Durham and Darlington NHS Trust, Darlington, UK. 7. Glasgow Caledonian University, Glasgow, UK. 8. Public Health England, London, UK.
Abstract
UNLABELLED: 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 assessed the cost-effectiveness of increased HCV case-finding and treatment in UK prisons using short-course therapies. 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 interferon (IFN)-free direct-acting antivirals (DAAs; 8-12 weeks, 95% sustained virological response, £3300/week). Costs (British pounds, £) and health utilities (quality-adjusted life years) were used to calculate mean incremental cost-effectiveness ratios (ICERs). We assumed 56% referral and 2.5%/25% of referred people who inject drugs (PWID)/ex-PWID treated within 2 months of diagnosis in prison. PWID and ex-PWID or non-PWID are in prison an average 4 and 8 months, respectively. Doubling prison testing rates with existing treatments produces a mean ICER of £19,850/quality-adjusted life years gained compared to current testing/treatment and is 45% likely to be cost-effective under a £20,000 willingness-to-pay threshold. Switching to 8-week to 12-week IFN-free DAAs in prisons could increase cost-effectiveness (ICER £15,090/quality-adjusted life years 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 with 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 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. (Hepatology 2016;63:1796-1808).
UNLABELLED: 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 assessed the cost-effectiveness of increased HCV case-finding and treatment in UK prisons using short-course therapies. 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 interferon (IFN)-free direct-acting antivirals (DAAs; 8-12 weeks, 95% sustained virological response, £3300/week). Costs (British pounds, £) and health utilities (quality-adjusted life years) were used to calculate mean incremental cost-effectiveness ratios (ICERs). We assumed 56% referral and 2.5%/25% of referred people who inject drugs (PWID)/ex-PWID treated within 2 months of diagnosis in prison. PWID and ex-PWID or non-PWID are in prison an average 4 and 8 months, respectively. Doubling prison testing rates with existing treatments produces a mean ICER of £19,850/quality-adjusted life years gained compared to current testing/treatment and is 45% likely to be cost-effective under a £20,000 willingness-to-pay threshold. Switching to 8-week to 12-week IFN-free DAAs in prisons could increase cost-effectiveness (ICER £15,090/quality-adjusted life years 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 with 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 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. (Hepatology 2016;63:1796-1808).
Authors: Ken Stein; Kim Dalziel; Andrew Walker; Becky Jenkins; Alison Round; Pam Royle Journal: J Public Health (Oxf) Date: 2004-03 Impact factor: 2.341
Authors: E Castelnuovo; J Thompson-Coon; M Pitt; M Cramp; U Siebert; A Price; K Stein Journal: Health Technol Assess Date: 2006-09 Impact factor: 4.014
Authors: P Thokala; E L Simpson; P Tappenden; J W Stevens; K Dickinson; S Ryder; P Harrison Journal: Pharmacoeconomics Date: 2016-08 Impact factor: 4.981
Authors: Adriaan J van der Meer; Bart J Veldt; Jordan J Feld; Heiner Wedemeyer; Jean-François Dufour; Frank Lammert; Andres Duarte-Rojo; E Jenny Heathcote; Michael P Manns; Lorenz Kuske; Stefan Zeuzem; W Peter Hofmann; Robert J de Knegt; Bettina E Hansen; Harry L A Janssen Journal: JAMA Date: 2012-12-26 Impact factor: 56.272
Authors: Martial L Ndeffo-Mbah; Vivian S Vigliotti; Laura A Skrip; Kate Dolan; Alison P Galvani Journal: Epidemiol Rev Date: 2018-06-01 Impact factor: 6.222
Authors: Pantelis Samartsidis; Natasha N Martin; Victor De Gruttola; Frank De Vocht; Sharon Hutchinson; Judith J Lok; Amy Puenpatom; Rui Wang; Matthew Hickman; Daniela De Angelis Journal: Stat Commun Infect Dis Date: 2021-10-11
Authors: Zoe Ward; Nyashadzaishe Mafirakureva; Jack Stone; Mary Keevans; Graham Betts-Symonds; Desmond Crowley; Tina McHugh; Gordana Avramovic; John S Lambert; Peter Vickerman Journal: Int J Drug Policy Date: 2021-08-17
Authors: E J Aspinall; W Mitchell; J Schofield; A Cairns; S Lamond; P Bramley; S E Peters; H Valerio; J Tomnay; D J Goldberg; P R Mills; S T Barclay; A Fraser; J F Dillon; N K Martin; M Hickman; S J Hutchinson Journal: J Viral Hepat Date: 2016-08-11 Impact factor: 3.728
Authors: Joanne Csete; Adeeba Kamarulzaman; Michel Kazatchkine; Frederick Altice; Marek Balicki; Julia Buxton; Javier Cepeda; Megan Comfort; Eric Goosby; João Goulão; Carl Hart; Thomas Kerr; Alejandro Madrazo Lajous; Stephen Lewis; Natasha Martin; Daniel Mejía; Adriana Camacho; David Mathieson; Isidore Obot; Adeolu Ogunrombi; Susan Sherman; Jack Stone; Nandini Vallath; Peter Vickerman; Tomáš Zábranský; Chris Beyrer Journal: Lancet Date: 2016-03-24 Impact factor: 79.321