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Hepatitis C treatment strategies in prisons: A cost-effectiveness analysis
In Australian prisons approximately 20% of inmates are chronically infected with hepatitis C virus (HCV), providing an important population for targeted treatment and prevention. A dynamic mathematical model of HCV transmission was used to assess the impact of increasing direct-acting antiviral (DAA...
Autores principales: | , , , , , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Public Library of Science
2021
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7877645/ https://www.ncbi.nlm.nih.gov/pubmed/33571196 http://dx.doi.org/10.1371/journal.pone.0245896 |
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author | Kwon, Jisoo A. Chambers, Georgina M. Luciani, Fabio Zhang, Lei Kinathil, Shamin Kim, Dennis Thein, Hla-Hla Botha, Willings Thompson, Sandra Lloyd, Andrew Yap, Lorraine Gray, Richard T. Butler, Tony |
author_facet | Kwon, Jisoo A. Chambers, Georgina M. Luciani, Fabio Zhang, Lei Kinathil, Shamin Kim, Dennis Thein, Hla-Hla Botha, Willings Thompson, Sandra Lloyd, Andrew Yap, Lorraine Gray, Richard T. Butler, Tony |
author_sort | Kwon, Jisoo A. |
collection | PubMed |
description | In Australian prisons approximately 20% of inmates are chronically infected with hepatitis C virus (HCV), providing an important population for targeted treatment and prevention. A dynamic mathematical model of HCV transmission was used to assess the impact of increasing direct-acting antiviral (DAA) treatment uptake on HCV incidence and prevalence in the prisons in New South Wales, Australia, and to assess the cost-effectiveness of alternate treatment strategies. We developed four separate models reflecting different average prison lengths of stay (LOS) of 2, 6, 24, and 36 months. Each model considered four DAA treatment coverage scenarios of 10% (status-quo), 25%, 50%, and 90% over 2016–2045. For each model and scenario, we estimated the lifetime burden of disease, costs and changes in quality-adjusted life years (QALYs) in prison and in the community during 2016–2075. Costs and QALYs were discounted 3.5% annually and adjusted to 2015 Australian dollars. Compared to treating 10% of infected prisoners, increasing DAA coverage to 25%, 50%, and 90% reduced HCV incidence in prisons by 9–33% (2-months LOS), 26–65% (6-months LOS), 37–70% (24-months LOS), and 35–65% (36-months LOS). DAA treatment was highly cost-effective among all LOS models at conservative willingness-to-pay thresholds. DAA therapy became increasingly cost-effective with increasing coverage. Compared to 10% treatment coverage, the incremental cost per QALY ranged from $497-$569 (2-months LOS), -$280–$323 (6-months LOS), -$432–$426 (24-months LOS), and -$245–$477 (36-months LOS). Treating more than 25% of HCV-infected prisoners with DAA therapy is highly cost-effective. This study shows that treating HCV-infected prisoners is highly cost-effective and should be a government priority for the global HCV elimination effort. |
format | Online Article Text |
id | pubmed-7877645 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2021 |
publisher | Public Library of Science |
record_format | MEDLINE/PubMed |
spelling | pubmed-78776452021-02-19 Hepatitis C treatment strategies in prisons: A cost-effectiveness analysis Kwon, Jisoo A. Chambers, Georgina M. Luciani, Fabio Zhang, Lei Kinathil, Shamin Kim, Dennis Thein, Hla-Hla Botha, Willings Thompson, Sandra Lloyd, Andrew Yap, Lorraine Gray, Richard T. Butler, Tony PLoS One Research Article In Australian prisons approximately 20% of inmates are chronically infected with hepatitis C virus (HCV), providing an important population for targeted treatment and prevention. A dynamic mathematical model of HCV transmission was used to assess the impact of increasing direct-acting antiviral (DAA) treatment uptake on HCV incidence and prevalence in the prisons in New South Wales, Australia, and to assess the cost-effectiveness of alternate treatment strategies. We developed four separate models reflecting different average prison lengths of stay (LOS) of 2, 6, 24, and 36 months. Each model considered four DAA treatment coverage scenarios of 10% (status-quo), 25%, 50%, and 90% over 2016–2045. For each model and scenario, we estimated the lifetime burden of disease, costs and changes in quality-adjusted life years (QALYs) in prison and in the community during 2016–2075. Costs and QALYs were discounted 3.5% annually and adjusted to 2015 Australian dollars. Compared to treating 10% of infected prisoners, increasing DAA coverage to 25%, 50%, and 90% reduced HCV incidence in prisons by 9–33% (2-months LOS), 26–65% (6-months LOS), 37–70% (24-months LOS), and 35–65% (36-months LOS). DAA treatment was highly cost-effective among all LOS models at conservative willingness-to-pay thresholds. DAA therapy became increasingly cost-effective with increasing coverage. Compared to 10% treatment coverage, the incremental cost per QALY ranged from $497-$569 (2-months LOS), -$280–$323 (6-months LOS), -$432–$426 (24-months LOS), and -$245–$477 (36-months LOS). Treating more than 25% of HCV-infected prisoners with DAA therapy is highly cost-effective. This study shows that treating HCV-infected prisoners is highly cost-effective and should be a government priority for the global HCV elimination effort. Public Library of Science 2021-02-11 /pmc/articles/PMC7877645/ /pubmed/33571196 http://dx.doi.org/10.1371/journal.pone.0245896 Text en © 2021 Kwon et al http://creativecommons.org/licenses/by/4.0/ This is an open access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0/) , which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. |
spellingShingle | Research Article Kwon, Jisoo A. Chambers, Georgina M. Luciani, Fabio Zhang, Lei Kinathil, Shamin Kim, Dennis Thein, Hla-Hla Botha, Willings Thompson, Sandra Lloyd, Andrew Yap, Lorraine Gray, Richard T. Butler, Tony Hepatitis C treatment strategies in prisons: A cost-effectiveness analysis |
title | Hepatitis C treatment strategies in prisons: A cost-effectiveness analysis |
title_full | Hepatitis C treatment strategies in prisons: A cost-effectiveness analysis |
title_fullStr | Hepatitis C treatment strategies in prisons: A cost-effectiveness analysis |
title_full_unstemmed | Hepatitis C treatment strategies in prisons: A cost-effectiveness analysis |
title_short | Hepatitis C treatment strategies in prisons: A cost-effectiveness analysis |
title_sort | hepatitis c treatment strategies in prisons: a cost-effectiveness analysis |
topic | Research Article |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7877645/ https://www.ncbi.nlm.nih.gov/pubmed/33571196 http://dx.doi.org/10.1371/journal.pone.0245896 |
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