Hepatitis C in a Prison in the North East of England: What Is the Economic Impact of the Universal Offer of Testing & Emergent Medications?
BACKGROUND:
Over
90% of new hepatitis C virus (HCV) infections occur in people who inject drugs
(PWIDs) and ∼60% of PWIDs have been in prescribed places of
detention (PPDs). In 2013, Public Health England, NHS England (NHSE) and the
National Offender Management Service published guidance on universal HCV
testing for PPDs. Recent National Institute of Health and Care Excellence
(NICE) guidance has recommended sofosbuvir for the treatment of genotype 1 disease,
with further guidance expected for ledipasvir-sofosbuvir for the treatment of
genotype 1 and 3 disease.
METHODS:
Health-care
representatives from Northumberland prison provided data on HCV testing and
treatment for 2013-14. Economic modelling of current screening and treatment
arrangements and future predicted costs (based on the universal offer of
testing and new treatments recently approved by NICE) was then undertaken.
RESULTS:
The
results of economic modelling suggest that current annual HCV costs at
Northumberland prison are around £300 675, but that costs could escalate to £1
625 794 with a 70% uptake of the universal offer of testing, and consideration
given to the higher costs associated with treatments approved by NICE.
CONCLUSIONS:
This
study demonstrates that costs associated with changes to testing and treating
HCV in PPDs have the potential to increase significantly for commissioners of
prison health-care services, and those funding medication.
- 1Health Protection Team, North East Public Health England Centre, Newcastle upon Tyne NE1 4WH, UK.
- 2Liver Unit, Freeman Hospital, Newcastle upon Tyne, Tyne and Wear NE7 7DN, UK.
- 3Health Improvement Team, North East Public Health England Centre, Newcastle upon Tyne NE15 8NY, UK.
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