François Girardin1, Natalie Hearmon2, Erika Castro3, Francesco Negro4, Lucy Eddowes2, Laurent Gétaz5,6, Hans Wolff5. 1. Medical Direction and Division of Clinical Pharmacology and Toxicology, Geneva University Hospitals, University of Geneva, Switzerland. 2. Costello Medical, Cambridge, United Kingdom. 3. Center for Addiction Medicine, Service of Community Psychiatry, Department of Psychiatry, University Hospital of Lausanne, Switzerland. 4. Divisions of Gastroenterology, Hepatology, and Clinical Pathology, Switzerland. 5. Division of Prison Health, Geneva University Hospitals, University of Geneva, Switzerland. 6. Division of Tropical and Humanitarian Medicine, Geneva University Hospitals, University of Geneva, Switzerland.
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.
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.
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: François Girardin; Chris Painter; Natalie Hearmon; Lucy Eddowes; Stefan Kaiser; Francesco Negro; Nathalie Vernaz Journal: JHEP Rep Date: 2021-03-18