1. Improved Health Outcomes from Hepatitis C Treatment Scale-Up in Spain's Prisons: A Cost-Effectiveness Study.
- Author
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Dalgic OO, Samur S, Spaulding AC, Llerena S, Cobo C, Ayer T, Roberts MS, Crespo J, and Chhatwal J
- Subjects
- Adult, Antiviral Agents therapeutic use, Female, Health Care Costs statistics & numerical data, Hepacivirus growth & development, Hepacivirus pathogenicity, Hepatitis C, Chronic drug therapy, Hepatitis C, Chronic transmission, Humans, Male, Middle Aged, Models, Statistical, Prevalence, Prisons, Quality-Adjusted Life Years, Spain epidemiology, Antiviral Agents economics, Cost-Benefit Analysis, Hepacivirus drug effects, Hepatitis C, Chronic economics, Hepatitis C, Chronic epidemiology, Prisoners
- Abstract
Hepatitis C virus (HCV) is 15 times more prevalent among persons in Spain's prisons than in the community. Recently, Spain initiated a pilot program, JAILFREE-C, to treat HCV in prisons using direct-acting antivirals (DAAs). Our aim was to identify a cost-effective strategy to scale-up HCV treatment in all prisons. Using a validated agent-based model, we simulated the HCV landscape in Spain's prisons considering disease transmission, screening, treatment, and prison-community dynamics. Costs and disease outcomes under status quo were compared with strategies to scale-up treatment in prisons considering prioritization (HCV fibrosis stage vs. HCV prevalence of prisons), treatment capacity (2,000/year vs. unlimited) and treatment initiation based on sentence lengths (>6 months vs. any). Scaling-up treatment by treating all incarcerated persons irrespective of their sentence length provided maximum health benefits-preventing 10,200 new cases of HCV, and 8,300 HCV-related deaths between 2019-2050; 90% deaths prevented would have occurred in the community. Compared with status quo, this strategy increased quality-adjusted life year (QALYs) by 69,700 and costs by €670 million, yielding an incremental cost-effectiveness ratio of €9,600/QALY. Scaling-up HCV treatment with DAAs for the entire Spanish prison population, irrespective of sentence length, is cost-effective and would reduce HCV burden.
- Published
- 2019
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