BACKGROUND:
The
prevalence of hepatitis C virus (HCV) in U.S. prisoners is high; however, HCV
testing and treatment are rare. Infected inmates released back into society
contribute to the spread of HCV in the general population. Routine hepatitis
screening of inmates followed by new therapies may reduce ongoing HCV
transmission.
OBJECTIVE:
To
evaluate the health and economic effect of HCV screening and treatment in
prisons on the HCV epidemic in society.
TIME HORIZON:
PERSPECTIVE:
INTERVENTIONS:
Risk-based
and universal opt-out hepatitis C screening in prisons, followed by treatment
in a portion of patients.
OUTCOME MEASURES:
Prevention
of HCV transmission and associated disease in prisons and society, costs,
quality-adjusted life years (QALYs), incremental cost-effectiveness ratio
(ICER), and total prison budget.
RESULTS OF BASE-CASE ANALYSIS:
Implementing
risk-based and opt-out screening could diagnose 41 900 to 122 700 new
HCV cases in prisons in the next 30 years. Compared with no screening, these
scenarios could prevent 5500 to 12 700 new HCV infections caused by
releasees, wherein about 90% of averted infections would have occurred outside
of prisons. HCV screening could also prevent 4200 to 11 700 liver-related
deaths. The ICERs of screening scenarios were $19 600 to
$29 200/QALY, and the respective first-year prison budget was $900 to
$1150 million. Prisons would require an additional 12.4% of their current
health care budget to implement such interventions.
RESULTS OF SENSITIVITY ANALYSIS:
Results
were sensitive to the time horizon, and ICERs otherwise remained less than
$50 000 per QALY.
LIMITATION:
Data
on transmission network, reinfection rate, and opt-out HCV screening rate are
lacking.
CONCLUSIONS:
Universal
opt-out HCV screening in prisons is highly cost-effective and would reduce HCV
transmission and HCV-associated diseases primarily in the outside community.
Investing in U.S. prisons to manage hepatitis C is a strategic approach to
address the current epidemic.
From the University of Pittsburgh, Pittsburgh, Pennsylvania; Tsinghua University School of Medicine, Beijing, China; University of Texas Health Science Center at Houston, Houston, Texas; Rollins School of Public Health, Emory University, and H. Milton Stewart School of Industrial and Systems Engineering, Georgia Institute of Technology, Atlanta, Georgia; and Institute for Technology Assessment, Massachusetts General Hospital, and Harvard Medical School, Boston, Massachusetts
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