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10.7326/M14-0602

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suck abstract from ncbi


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pmid25329202      Ann+Intern+Med 2014 ; 161 (8): 546-53
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  • Sofosbuvir-Based Treatment Regimens for Chronic, Genotype 1 Hepatitis C Virus Infection in U S Incarcerated Populations: A Cost-Effectiveness Analysis #MMPMID25329202
  • Liu S; Watcha D; Holodniy M; Goldhaber-Fiebert JD
  • Ann Intern Med 2014[Oct]; 161 (8): 546-53 PMID25329202show ga
  • Background: Prevalence of chronic hepatitis C virus (HCV) infection is high among incarcerated persons in the United States. New, short-duration, high-efficacy therapies may expand treatment eligibility in this population. Objective: To assess the cost-effectiveness of sofosbuvir for HCV treatment in incarcerated populations. Design: Markov model. Data Sources: Published literature and expert opinion. Target Population: Treatment-naive men with chronic, genotype 1 HCV monoinfection. Time Horizon: Lifetime. Perspective: Societal. Intervention: No treatment, 2-drug therapy (pegylated interferon and ribavirin), or 3-drug therapy with either boceprevir or sofosbuvir. For inmates with short remaining sentences (<1.5 years), only no treatment or sofosbuvir 3-drug therapy were feasible; for those with long sentences (?1.5 years; mean, 10 years), all strategies were considered. After release, eligible persons could receive sofosbuvir 3-drug therapy. Outcome Measures: Discounted costs (in 2013 U.S. dollars), discounted quality-adjusted life-years (QALYs), and incremental cost-effectiveness ratios. Results of Base-Case Analysis: The strategies yielded 13.12, 13.57, 14.43, and 15.18 QALYs, respectively, for persons with long sentences. Sofosbuvir produced the largest absolute reductions in decompensated cirrhosis (16%) and hepatocellular carcinoma (9%), resulting in 2.1 additional QALYs at an added cost exceeding $54 000 compared with no treatment. For persons with short sentences, sofosbuvir cost $25 700 per QALY gained compared with no treatment; for those with long sentences, it dominated other treatments, costing $28 800 per QALY gained compared with no treatment. Results of Sensitivity Analysis: High reinfection rates in prison attenuated cost-effectiveness for persons with long sentences. Limitations: Data on sofosbuvir?s long-term effectiveness and price are limited. The analysis did not consider women, Hispanic persons, or patients co-infected with HIV or hepatitis B virus. Conclusion: Sofosbuvir-based treatment is cost-effective for incarcerated persons, but affordability is an important consideration. Primary Funding Source: National Institutes of Health.
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