Home > Cost-effectiveness of mass screening for hepatitis C virus in Irish prisons.

Millar, Sean (2022) Cost-effectiveness of mass screening for hepatitis C virus in Irish prisons. Drugnet Ireland, Issue 83, Winter 2022, p. 15.

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Background and methods

There is a high proportion of people who inject drugs (PWID) in Irish prisons and a high prevalence of hepatitis C virus (HCV), making prison a high priority setting for HCV testing and treatment. However, HCV screening in Irish prisons currently occurs intermittently. Although every prisoner undergoes a committal health screening on entering prison and information is gathered on drug use and blood-borne virus testing is offered, many prisoners initially refuse, but then return later and request screening.1

A 2021 Irish study2 evaluated the cost-effectiveness of a mass HCV screening intervention in Mountjoy Prison, Dublin, compared with the standard-of-care intermittent screening on committal. In this research, published in the International Journal of Drug Policy, primary cost data were collected from the intervention using an overall provider perspective. Standard-of-care costs were estimated through interview. All costs were inflated to 2020 euros. A HCV transmission and disease progression model among incarcerated and community PWID and ex-injectors was calibrated to the Dublin HCV epidemic, allowing inclusion of population-level health benefits. The model used intervention data suggesting 419 individuals were screened, 50 HCV infections diagnosed, and that 32 individuals underwent treatment.

Results

The study found that the total direct costs of the intervention (not including treatment drug costs) was €82,392, with most costs being due to staff (43%) and overhead or management costs (38%). Despite having little epidemiological impact due to the small numbers treated, over 50 years the incremental cost of the intervention was €36,592.

Conclusions

The authors noted that mass HCV screening in Dublin prisons is unlikely to have a large prevention impact on the overall HCV epidemic among PWID, with yearly screening only reducing the number of new HCV infections by 1.1%. This small impact is due to the low levels of incarceration among PWID in Dublin and negligible HCV risk in prison. Nevertheless, they suggest that this should not be seen as a reason for not doing screening and treatment in prison, as it is likely to be highly cost-effective (and possibly cost-saving) and may reach individuals not well reached by other testing initiatives.

 

1  Health Research Board (2022) Focal Point Ireland: national report for 2021 – prison. Dublin: Health Research Board. https://www.drugsandalcohol.ie/25265/

2. Ward Z, Mafirakureva N, Stone J, et al. (2021) Cost-effectiveness of mass screening for hepatitis C virus among all inmates in an Irish prison. Int J Drug Policy, 96: 103394. https://www.drugsandalcohol.ie/34897/

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