A Budget Impact Analysis of Newly Available Hepatitis C Therapeutics and the Financial Burden on a State Correctional System

Hepatitis C virus (HCV) infection continues to disproportionately affect incarcerated populations. New HCV drugs present opportunities and challenges to address HCV in corrections. 

The goal of this study was to evaluate the impact of the treatment costs for HCV infection in a state correctional population through a budget impact analysis comparing differing treatment strategies. Electronic and paper medical records were reviewed to estimate the prevalence of hepatitis C within the Rhode Island Department of Corrections. 

Three treatment strategies were evaluated as follows: 

1. treating all chronically infected persons, 
2. treating only patients with demonstrated fibrosis, and 
3. treating only patients with advanced fibrosis. 

Budget impact was computed as the percentage of pharmacy and overall healthcare expenditures accrued by total drug costs assuming entirely interferon-free therapy. Sensitivity analyses assessed potential variance in costs related to variability in HCV prevalence, genotype, estimated variation in market pricing, length of stay for the sentenced population, and uptake of newly available regimens. 

Chronic HCV prevalence was estimated at 17% of the total population. Treating all sentenced inmates with at least 6 months remaining of their sentence would cost about $34 million-13 times the pharmacy budget and almost twice the overall healthcare budget. Treating inmates with advanced fibrosis would cost about $15 million. A hypothetical 50% reduction in total drug costs for future therapies could cost $17 million to treat all eligible inmates. 

With immense costs projected with new treatment, it is unlikely that correctional facilities will have the capacity to treat all those afflicted with HCV. Alternative payment strategies in collaboration with outside programs may be necessary to curb this epidemic. In order to improve care and treatment delivery, drug costs also need to be seriously reevaluated to be more accessible and equitable now that HCV is more curable.

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By:  Nguyen JT1, Rich JD, Brockmann BW, Vohr F, Spaulding A, Montague BT.

• 1Brown University School of Public Health, Providence, RI, USA. 
• J Urban Health. 2015 Aug;92(4):635-49. doi: 10.1007/s11524-015-9953-4.

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New Era in HCV Management: Primary Care Innovations

Via:  https://goo.gl/pquiNB

Is Increased HCV Case-Finding Combined with Current or 8-12 Week DAA Therapy Cost-Effective in UK Prisons? A Prevention Benefit Analysis

BACKGROUND:

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 assess the cost-effectiveness of increased HCV case-finding and treatment in UK prisons using short-course therapies.

METHODS:

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 IFN-free DAAs(8-12 weeks, 95% SVR, £3300/wk). Costs(GBP£) and health utilities(quality-adjusted life-years,QALYs) were used to calculate mean incremental cost-effectiveness ratios(ICERs). We assume 56% referral and 2.5%/25% of referred people who inject drugs(PWID)/exPWID treated within 2 months of diagnosis in prison. PWID and ex/nonPWID are in prison an average 4/8 months, respectively.

RESULTS:

Doubling prison testing rates with existing treatments produces a mean ICER of £19,850/QALY gained compared to current testing/treatment, and is 45% likely to be cost-effective under a £20,000 willingness-to-pay(WTP) threshold. Switching to 8-12 week IFN-free DAAs in prisons could increase cost-effectiveness(ICER £15,090/QALY 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(ICER<£13,000). HCV case-finding and IFN-free DAAs could be highly cost-effective if DAA cost is 10% lower or 8 weeks duration. Conclusions 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 WTP 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.

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By:  Martin NK1,2, Vickerman P2, Brew IF3, Williamson J3, Miners A4, Irving WL5, Saksena S6, Hutchinson SJ7, Mandal S8, O'Moore E8, Hickman M2.

• 1Division of Global Public Health, University of California San Diego, USA.
• 2School of Social and Community Medicine, University of Bristol, UK.
• 3Leeds Community Healthcare NHS Trust, UK.
• 4London School of Hygiene and Tropical Medicine, UK.
• 5University of Nottingham, UK.
• 6County Durham and Darlington NHS Trust, UK.
• 7Glasgow Caledonian University, UK.
• 8Public Health England, UK. 
• Hepatology. 2016 Feb 10. doi: 10.1002/hep.28497.

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Personality Disorders among Spanish Prisoners Starting Hepatitis C Treatment: Prevalence & Associated Factors

The purpose of this study was to assess the prevalence of personality disorders (PDs) and their associated factors in prisoners who initiate chronic hepatitis C (CHC) treatment in 25 Spanish prisons. 

The Personality Diagnostic Questionnaire-4 was used to diagnose PDs according to DSM-IV criteria. Factors potentially associated with a PD diagnosis were evaluated by logistic regression analysis. Two hundred and fifty-five patients were initially assessed and 62 (24.3%) were excluded due to an incomplete or invalid self-report screening questionnaire. PD prevalence was 70.5%, with antisocial PD being the most prevalent (46.1%). In terms of PD clusters, the most prevalent was cluster-B (55.4%). 

PD diagnosis was associated with HCV genotypes 1, 2, or 3. Patients with a cluster-B PD were more likely to be infected with HCV genotypes 1, 2, or 3 and be HIV-infected, to report past-year injection drug use, and to have stage 3 or 4 fibrosis. The prevalence of PDs in Spanish prisoners who initiate CHC treatment is very high. PD management issues should be considered in treating CHC patients in prisons.

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By:  Marco A1, Antón JJ2, Saiz de la Hoya P3, de Juan J4, Faraco I5, Caylà JA6, Trujols J7; PERSEO Group.

• 1Health Services of Barcelona Men's Penitentiary Centre, Barcelona, Spain.
• 2Health Services of Albolote Penitentiary Centre, Granada, Spain.
• 3Health Services of Fontcalent Penitentiary Centre, Alicante, Spain.
• 4Health Services of Córdoba Penitentiary Centre, Córdoba, Spain.
• 5Health Services of Sevilla Penitentiary Centre, Sevilla, Spain.
• 6Epidemiology Service, Public Health Agency of Barcelona, CIBER de Epidemiología y Salud Pública (CIBERESP), Spain.
• 7Department of Psychiatry, Hospital de la Santa Creu i Sant Pau, Sant Pau Biomedical Research Institute (IIB Sant Pau), CIBER de Salud Mental (CIBERSAM), Barcelona, Spain. Electronic address: jtrujols@santpau.cat. 

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The Cascade of Care for an Australian Community-Based Hepatitis C Treatment Service

Hepatitis C treatment uptake in Australia is low. To increase access to hepatitis C virus treatment for people who inject drugs, we developed a community-based, nurse-led service that linked a viral hepatitis service in a tertiary hospital to primary care clinics, and resulted in hepatitis C treatment provision in the community.

A retrospective cohort study of patients referred to the community hepatitis service was undertaken to determine the cascade of care. Logistic regression analyses were used to identify predictors of hepatitis C treatment uptake.

Four hundred and sixty-two patients were referred to the community hepatitis service; 344 attended. Among the 279 attendees with confirmed chronic hepatitis C, 257 (99%) reported ever injecting drugs, and 124 (48%) injected in the last month. Of 201 (72%) patients who had their fibrosis staged, 63 (31%) had F3-F4 fibrosis. Fifty-five patients commenced hepatitis C treatment; 26 (47%) were current injectors and 25 (45%) had F3-F4 fibrosis. Nineteen of the 27 (70%) genotype 1 patients and 14 of the 26 (54%) genotype 3 patients eligible for assessment achieved a sustained virologic response. Advanced fibrosis was a significant predictor of treatment uptake in adjusted analysis (AOR 2.56, CI 1.30–5.00, p = 0.006).

Our community hepatitis service produced relatively high rates of fibrosis assessment, hepatitis C treatment uptake and cure, among people who inject drugs. These findings highlight the potential benefits of providing community-based hepatitis C care to people who inject drugs in Australia–benefits that should be realised as direct-acting antiviral agents become available.

Below:  HCV Cascade of care in Australia

Full article at:  http://goo.gl/FW9kYs

By: 

Amanda J. Wade, Joseph S. Doyle, Margaret E. Hellard

Centre for Population Health, Burnet Institute, Melbourne, Victoria, Australia

Amanda J. Wade, Margaret E. Hellard

School of Public Health and Preventive Medicine, Monash University, Alfred Hospital, Melbourne, Victoria, Australia

Diana M. Macdonald, Joseph S. Doyle, Margaret E. Hellard

Department of Infectious Diseases, The Alfred, Melbourne, Victoria, Australia

Alexander J. Thompson

Department of Gastroenterology, St Vincent’s Hospital, Melbourne, Victoria, Australia

Adam Gordon, Stuart K. Roberts

Department of Gastroenterology, The Alfred, Melbourne, Victoria, Australia

Stuart K. Roberts, Alexander J. Thompson

Department of Medicine, Monash University, Melbourne, Victoria, Australia

Joseph S. Doyle

Department of Medicine, The University of Melbourne, Melbourne, Victoria, Australia

 

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