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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...

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Autores principales: 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
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Public Library of Science 2021
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.
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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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