Estimating the cost-effectiveness of detecting cases of chronic hepatitis C infection on reception into prison


Sutton, AJ; Edmunds, WJ; Gill, ON; (2006) Estimating the cost-effectiveness of detecting cases of chronic hepatitis C infection on reception into prison. BMC Public Health, 6. p. 170. ISSN 1471-2458 DOI: https://doi.org/10.1186/1471-2458-6-170

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Abstract

BACKGROUND: In England and Wales where less than 1% of the population are Injecting drug users (IDUs), 97% of HCV reports are attributed to injecting drug use. As over 60% of the IDU population will have been imprisoned by the age of 30 years, prison may provide a good location in which to offer HCV screening and treatment. The aim of this work is to examine the cost effectiveness of a number of alternative HCV case-finding strategies on prison reception METHODS: A decision analysis model embedded in a model of the flow of IDUs through prison was used to estimate the cost effectiveness of a number of alternative case-finding strategies. The model estimates the average cost of identifying a new case of HCV from the perspective of the health care provider and how these estimates may evolve over time. RESULTS: The results suggest that administering verbal screening for a past positive HCV test and for ever having engaged in illicit drug use prior to the administering of ELISA and PCR tests can have a significant impact on the cost effectiveness of HCV case-finding strategies on prison reception; the discounted cost in 2017 being pound2,102 per new HCV case detected compared to pound3,107 when no verbal screening is employed. CONCLUSION: The work here demonstrates the importance of targeting those individuals that have ever engaged in illicit drug use for HCV testing in prisons, these individuals can then be targeted for future intervention measures such as treatment or monitored to prevent future transmission.

Item Type: Article
Keywords: Adult, Blood-Borne Pathogens, *Cost-Benefit Analysis, *Decision Support Techniques, England/epidemiology, Enzyme-Linked Immunosorbent Assay/economics, Hepatitis C, Chronic/*diagnosis/economics/epidemiology, Humans, Mass Screening/*economics/methods, Middle Aged, Polymerase Chain Reaction/economics, Prisoners/*statistics & numerical data, Prisons/economics, Risk Assessment/economics, Substance Abuse, Intravenous/*complications/virology, Wales/epidemiology, Adult, Blood-Borne Pathogens, Cost-Benefit Analysis, Decision Support Techniques, England, epidemiology, Enzyme-Linked Immunosorbent Assay, economics, Hepatitis C, Chronic, diagnosis, economics, epidemiology, Humans, Mass Screening, economics, methods, Middle Aged, Polymerase Chain Reaction, economics, Prisoners, statistics & numerical data, Prisons, economics, Risk Assessment, economics, Substance Abuse, Intravenous, complications, virology, Wales, epidemiology
Faculty and Department: Faculty of Epidemiology and Population Health > Dept of Infectious Disease Epidemiology
PubMed ID: 16803622
Web of Science ID: 239803500001
URI: http://researchonline.lshtm.ac.uk/id/eprint/6818

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