OBJECTIVES: World Health Organisation recommends the treatment of all HCV+ patients in order to achieve virus elimination. Although chronic hepatitis C (CHC) prevalence amongst prisoners is high, many prisoners with CHC remain untreated. The objective of this study was to evaluate long-term healthcare benefits and economic outcomes of treating prisoners with CHC with direct-acting antivirals (DAAs) in Spain.

METHODS: A lifetime Markov model was used to simulate the treatment and disease pathway of a cohort of 4,408 CHC prisoners treated with DAAs versus no treatment. It was assumed that the cohort was treated over two years (50% of patients each year). Cohort baseline characteristics (average age, genotype distribution and fibrosis) were identified from published Spanish prisoner studies and sustained virological response rates from Spanish real-world data. Untreated patients progressed according to the disease’s natural history. Transition probabilities, utilities and cost of health states were obtained from published literature and drug costs from Spanish public sources. The model estimated the cumulative incidence of liver complications and deaths, quality-adjusted life years (QALY), total costs, and incremental cost-effectiveness ratio (ICER). A National Healthcare System perspective was adopted with a 3% annual discount rate for costs and health outcomes. One-way sensitivity analyses (OWSA) were conducted.

RESULTS: In the DAA treated cohort, the model estimated 88% reduction in liver-related deaths (-1,110 deaths) and relevant reductions in liver complications: 92% in decompensated cirrhosis (-951 cases), 83% in hepatocellular carcinoma (-650 cases) and 90% of liver transplants (-132). DAA treatment yielded 5.0 additional QALYs (21.2 vs 16.2) and incremental cost of €3,473 (€24,088 vs €20,615), resulting in an ICER of €690/QALY. OWSA confirmed the robustness of the results.

CONCLUSIONS: DAA treatment of all prisoners with CHC not only decreases morbidity, mortality and the need for liver transplantation but is also a highly cost-effective strategy.