Improved Health Outcomes from Hepatitis C Treatment Scale-Up in Spain’s Prisons: A Cost-Effectiveness Study

• Published in: Scientific reports Vol. 9; no. 1; pp. 16849 - 11
• Main Authors: Dalgic, Ozden O., Samur, Sumeyye, Spaulding, Anne C., Llerena, Susana, Cobo, Carmen, Ayer, Turgay, Roberts, Mark S., Crespo, Javier, Chhatwal, Jagpreet
• Format: Journal Article
• Language: English
• Published: London Nature Publishing Group UK 14-11-2019; Nature Publishing Group
• Subjects: 692/699/255/234/2513/1551; 692/700/1538; 692/700/3934; 692/700/478/174; 692/700/478/2772; Adult; Antiviral agents; Antiviral Agents - economics; Antiviral Agents - therapeutic use; Cost analysis; Cost-Benefit Analysis; Criminal sentences; Disease transmission; Female; Fibrosis; Health Care Costs - statistics & numerical data; Hepacivirus - drug effects; Hepacivirus - growth & development; Hepacivirus - pathogenicity; Hepatitis; Hepatitis C; Hepatitis C, Chronic - drug therapy; Hepatitis C, Chronic - economics; Hepatitis C, Chronic - epidemiology; Hepatitis C, Chronic - transmission; Humanities and Social Sciences; Humans; Male; Middle Aged; Models, Statistical; multidisciplinary; Prevalence; Prisoners; Prisons; Quality-Adjusted Life Years; Science; Science (multidisciplinary); Spain - epidemiology; Spain
• ISSN: 2045-2322; 2045-2322
• DOI: 10.1038/s41598-019-52564-0

Hepatitis C virus (HCV) is 15 times more prevalent among persons in Spain’s prisons than in the community. Recently, Spain initiated a pilot program, JAILFREE-C, to treat HCV in prisons using direct-acting antivirals (DAAs). Our aim was to identify a cost-effective strategy to scale-up HCV treatment in all prisons. Using a validated agent-based model, we simulated the HCV landscape in Spain’s prisons considering disease transmission, screening, treatment, and prison-community dynamics. Costs and disease outcomes under status quo were compared with strategies to scale-up treatment in prisons considering prioritization (HCV fibrosis stage vs. HCV prevalence of prisons), treatment capacity (2,000/year vs. unlimited) and treatment initiation based on sentence lengths (>6 months vs. any). Scaling-up treatment by treating all incarcerated persons irrespective of their sentence length provided maximum health benefits–preventing 10,200 new cases of HCV, and 8,300 HCV-related deaths between 2019–2050; 90% deaths prevented would have occurred in the community. Compared with status quo, this strategy increased quality-adjusted life year (QALYs) by 69,700 and costs by €670 million, yielding an incremental cost-effectiveness ratio of €9,600/QALY. Scaling-up HCV treatment with DAAs for the entire Spanish prison population, irrespective of sentence length, is cost-effective and would reduce HCV burden.