Implementing opt-out hepatitis C virus (HCV) screening in Canadian provincial prisons: A model-based cost-effectiveness analysis
| Autor: | Léa Duchesne, Mathieu Maheu-Giroux, Nadine Kronfli, Camille Dussault, Arnaud Godin |
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| Rok vydání: | 2021 |
| Předmět: |
Canada
Standard of care Cost-Benefit Analysis media_common.quotation_subject Hepatitis C virus Psychological intervention 030508 substance abuse Medicine (miscellaneous) Prison Hepacivirus medicine.disease_cause Opt-out 03 medical and health sciences 0302 clinical medicine Seroepidemiologic Studies Humans Mass Screening Medicine 030212 general & internal medicine health care economics and organizations media_common Venipuncture business.industry Health Policy virus diseases Cost-effectiveness analysis Hepatitis C Prisons Cohort 0305 other medical science business Demography |
| Zdroj: | International Journal of Drug Policy. 96:103345 |
| ISSN: | 0955-3959 |
| Popis: | Background Implementing opt-out hepatitis C virus (HCV) screening across Canadian provincial prisons is crucial to achieving micro-elimination. Given short incarceration lengths, the most cost-effective screening strategy remains unknown. We compared the cost-effectiveness of current standard of care (venipuncture-based HCV-antibody+HCV RNA) and 13 alternative strategies in Quebec's largest provincial prison. Methods A prison cohort was simulated with a Markov micro-simulation model. Strategies differed in the biomarkers, sampling methods, and number of tests used. The model considered incarceration lengths, time to linkage to care (LTC), nursing costs, and tests’ costs, performances, acceptability and turnaround times. Outcomes included costs (Canadian dollars, CAD$), number of true positives linked to care, and incremental cost-effectiveness ratios (ICERs, additional $/additional TP-L). A one-year time horizon and health-payer perspective were adopted. Results Across all analyses, three strategies consistently provided the best value for money: venipuncture-based HCV-antibody+HCV-core antigen, venipuncture-based HCV-core antigen (base-case ICER=~ $720), and point-of-care HCV-antibody+HCV RNA (base-case ICER=$4,310). However, these strategies linked only 23%-29% viremic individuals to care. Main drivers of cost-effectiveness were the seroprevalence, proportion viremic, and time to LTC. Conclusion Alternative strategies would be more cost-effective than standard of care for implementing opt-out screening in provincial prisons. However, interventions to maximize LTC should be explored. |
| Databáze: | OpenAIRE |
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