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Revista Española de Sanidad Penitenciaria
versión On-line ISSN 2013-6463versión impresa ISSN 1575-0620
Resumen
MARCO, A; DOMINGUEZ-HERNANDEZ, R y CASADO, MA. Cost-effectiveness analysis of chronic hepatitis C treatment in the prison population in Spain. Rev. esp. sanid. penit. [online]. 2020, vol.22, n.2, pp.66-74. Epub 05-Oct-2020. ISSN 2013-6463. https://dx.doi.org/10.18176/resp.00012.
Objectives:
To evaluate the cost-effectiveness of direct-acting antiviral (DAAs) treatment versus non-treatment in prisoners awaiting treatment for chronic hepatitis C (CHC) and to analyse the clinical and economic impact of the treatment on liver complications and mortality.
Material and method:
A lifetime Markov model was developed to simulate treatment and disease progression from an estimated cohort of 4,408 CHC prisoners treated with DAAs over 2 years (50% of patient each year) versus no treatment. In the treated cohort, a sustained viral response of 95% was associated. Patient characteristics, transition probabilities, utilities and costs (pharmacological and healthcare states) were obtained from published literature. The model estimated healthcare costs and benefits, incremental cost-utility ratio (ICUR) based on total costs and the quality-adjusted life year (QALY) and avoided clinical events. A National Healthcare System perspective was adopted with a 3% annual discount rate for both costs and health outcomes. Sensitivity analyses were performed to assess uncertainty.
Results:
In the DDA treated cohort, the model estimated a decrease of 92% of decompensated cirrhosis and 83% of hepatocellular carcinoma, 88% liver-related mortality cases were reduced, 132 liver transplants were avoided. The treatment achieved an additional 5.0/QALYs (21.2 vs. 16.2) with an incremental cost of €3,473 (€24,088 vs. €20,615) per patient with an ICUR of €690 per QALY gained.
Discussion:
Considering the willingness-to-pay threshold used in Spain (€22,000-30,000/QALY), DAAs treatment for prisoners with CHC is a highly cost-effective strategy, reduces infection transmission, increases survival and reduces complications due to liver disease, as well as the cost associated with its management.
Palabras clave : Prisons; Chronic hepatitis C; Cost-effectiveness analysis; Public health.