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. 2021 Oct:96:103345.
doi: 10.1016/j.drugpo.2021.103345. Epub 2021 Jun 25.

Implementing opt-out hepatitis C virus (HCV) screening in Canadian provincial prisons: A model-based cost-effectiveness analysis

Léa Duchesne  1 , Camille Dussault  2 , Arnaud Godin  3 , Mathieu Maheu-Giroux  3 , Nadine Kronfli  4
Affiliations

Implementing opt-out hepatitis C virus (HCV) screening in Canadian provincial prisons: A model-based cost-effectiveness analysis

Léa Duchesne et al. Int J Drug Policy. 2021 Oct.

Abstract

Background: Implementing opt-out hepatitis C virus (HCV) screening across Canadian provincial prisons is crucial to achieving micro-elimination. Given short incarceration lengths, the most cost-effective screening strategy remains unknown. We compared the cost-effectiveness of current standard of care (venipuncture-based HCV-antibody+HCV RNA) and 13 alternative strategies in Quebec's largest provincial prison.

Methods: A prison cohort was simulated with a Markov micro-simulation model. Strategies differed in the biomarkers, sampling methods, and number of tests used. The model considered incarceration lengths, time to linkage to care (LTC), nursing costs, and tests' costs, performances, acceptability and turnaround times. Outcomes included costs (Canadian dollars, CAD$), number of true positives linked to care, and incremental cost-effectiveness ratios (ICERs, additional $/additional TP-L). A one-year time horizon and health-payer perspective were adopted.

Results: Across all analyses, three strategies consistently provided the best value for money: venipuncture-based HCV-antibody+HCV-core antigen, venipuncture-based HCV-core antigen (base-case ICER=~ $720), and point-of-care HCV-antibody+HCV RNA (base-case ICER=$4,310). However, these strategies linked only 23%-29% viremic individuals to care. Main drivers of cost-effectiveness were the seroprevalence, proportion viremic, and time to LTC.

Conclusion: Alternative strategies would be more cost-effective than standard of care for implementing opt-out screening in provincial prisons. However, interventions to maximize LTC should be explored.

Keywords: Cost-effectiveness analysis; Hepatitis C virus; Linkage to care; Opt-out screening; Prison; prison.

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Conflict of interest statement

Declarations of Interest The authors have no conflict of interest with regard to this study and there was no pharmaceutical industry support to conduct this study. LD, CD and AG report no conflicts of interest. MMG reports an investigator-sponsored research grant from Gilead Sciences Inc. MMG reports contractual arrangements with the World Health Organization, the Institut national de santé publique du Québec, and the Institut d'excellence en santé et services sociaux, all outside of the submitted work. NK reports research funding from Gilead Sciences, advisory fees from Gilead Sciences, ViiV Healthcare, Merck and Abbvie, and speaker fees from Gilead Sciences and Merck.

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