Sofosbuvir-based treatment regimens for chronic, genotype 1 hepatitis C virus infection in U.S. incarcerated populations: a cost-effectiveness analysis

Ann Intern Med. 2014 Oct 21;161(8):546-53. doi: 10.7326/M14-0602.


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 was 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.

Publication types

  • Research Support, N.I.H., Extramural
  • Research Support, U.S. Gov't, Non-P.H.S.

MeSH terms

  • Adult
  • Antiviral Agents / economics
  • Antiviral Agents / therapeutic use*
  • Cost-Benefit Analysis
  • Drug Costs
  • Drug Therapy, Combination
  • Hepacivirus / genetics
  • Hepatitis C, Chronic / drug therapy*
  • Humans
  • Interferon-alpha / therapeutic use
  • Male
  • Polyethylene Glycols / therapeutic use
  • Prisoners*
  • Proline / analogs & derivatives
  • Proline / therapeutic use
  • Quality-Adjusted Life Years
  • Ribavirin / therapeutic use
  • Sofosbuvir
  • United States
  • Uridine Monophosphate / analogs & derivatives*
  • Uridine Monophosphate / economics
  • Uridine Monophosphate / therapeutic use


  • Antiviral Agents
  • Interferon-alpha
  • Polyethylene Glycols
  • Ribavirin
  • N-(3-amino-1-(cyclobutylmethyl)-2,3-dioxopropyl)-3-(2-((((1,1-dimethylethyl)amino)carbonyl)amino)-3,3-dimethyl-1-oxobutyl)-6,6-dimethyl-3-azabicyclo(3.1.0)hexan-2-carboxamide
  • Proline
  • Uridine Monophosphate
  • Sofosbuvir