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

Autor: Sharon J. Hutchinson, Éamonn O'Moore, Alec Miners, Matthew Hickman, Sushma Saksena, Iain F. Brew, Natasha K. Martin, Sema Mandal, William L. Irving, Joan Williamson, Peter Vickerman
Rok vydání: 2015
Předmět:
Pediatrics
Comparative Effectiveness Research
Sustained Virologic Response
Cost-Benefit Analysis
Prison
Medical Biochemistry and Metabolomics
medicine.disease_cause
Hepatitis
Substance Misuse
0302 clinical medicine
Theoretical
Models
Mass Screening
030212 general & internal medicine
Young adult
health care economics and organizations
media_common
Cost–benefit analysis
Liver Disease
Hepatitis C
Health Services
Middle Aged
Infectious Diseases
HIV/AIDS
030211 gastroenterology & hepatology
Infection
Adult
medicine.medical_specialty
Referral
Adolescent
Hepatitis C virus
media_common.quotation_subject
Chronic Liver Disease and Cirrhosis
Clinical Sciences
Immunology
Antiviral Agents
Article
03 medical and health sciences
Young Adult
Hepatitis - C
Clinical Research
Internal medicine
medicine
Humans
Aged
Hepatology
Gastroenterology & Hepatology
business.industry
Prisoners
Models
Theoretical
medicine.disease
United Kingdom
Emerging Infectious Diseases
Good Health and Well Being
Cost Effectiveness Research
Economic evaluation
business
Digestive Diseases
Zdroj: Hepatology (Baltimore, Md.), vol 63, iss 6
Martin, N K, Vickerman, P, Brew, I F, Williamson, J, Miners, A, Irving, W L, Saksena, S, Hutchinson, S J, Mandal, S, O'Moore, E & Hickman, M 2016, ' 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 ', Hepatology, vol. 63, no. 6, pp. 1796-1808 . https://doi.org/10.1002/hep.28497
ISSN: 1527-3350
DOI: 10.1002/hep.28497
Popis: 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 (ICERCONCLUSIONS: 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).
Databáze: OpenAIRE
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