A costing analysis of a state-wide, nurse-led hepatitis C treatment model in prison

Anna Palmer; Timothy Papaluca; Mark Stoové; Rebecca Winter; Alisa Pedrana; Margaret Hellard; David Wilson; Alexander Thompson; Nick Scott; EC Victoria Partnership

doi:10.1016/j.drugpo.2021.103203

A costing analysis of a state-wide, nurse-led hepatitis C treatment model in prison

Int J Drug Policy. 2021 Aug:94:103203. doi: 10.1016/j.drugpo.2021.103203. Epub 2021 Mar 18.

Authors

Anna Palmer¹, Timothy Papaluca², Mark Stoové³, Rebecca Winter⁴, Alisa Pedrana³, Margaret Hellard⁵, David Wilson⁶, Alexander Thompson², Nick Scott³; EC Victoria Partnership

Affiliations

¹ Disease Elimination Program, Burnet Institute, Melbourne, Victoria, Australia. Electronic address: anna.palmer@burnet.edu.au.
² Department of Gastroenterology, St Vincent's Hospital Melbourne, Fitzroy, Victoria, Australia; Department of Medicine, The University of Melbourne, Parkville, Victoria, Australia.
³ Disease Elimination Program, Burnet Institute, Melbourne, Victoria, Australia; School of Population Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia.
⁴ Disease Elimination Program, Burnet Institute, Melbourne, Victoria, Australia; Department of Gastroenterology, St Vincent's Hospital Melbourne, Fitzroy, Victoria, Australia.
⁵ Disease Elimination Program, Burnet Institute, Melbourne, Victoria, Australia; School of Population Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia; Department of Infectious Diseases, The Alfred and Monash University, Melbourne, Victoria, Australia; Peter Doherty Institute for Infection and Immunity, Parkville, Victoria, Australia; School of Population and Global Health, The University of Melbourne, Parkville, Victoria, Australia.
⁶ Disease Elimination Program, Burnet Institute, Melbourne, Victoria, Australia.

PMID: 33744667
DOI: 10.1016/j.drugpo.2021.103203

Abstract

Background: Hepatitis C is highly prevalent among prisoners. The simplicity of direct-acting antiviral (DAA) treatment for hepatitis C makes it possible to use novel models of care to increase treatment uptake within prisons. We estimate the average non-drug cost of initiating a prisoner on treatment using real world data from the State-wide Hepatitis Program (SHP) in Victoria, Australia - a coordinated nurse-led model of care.

Methods: Data were considered from prisoners presenting to the SHP (following antibody-positive diagnosis) during the evaluation period, November 2015 to December 2016. All costs associated with the SHP were estimated, including staffing salaries, medical tests, pharmacy costs and overhead costs. DAA costs were excluded as in Australia an unlimited number are available, covered by a federal government risk-sharing agreement with pharmaceutical companies. The average non-drug cost of treatment initiation through the SHP was compared to equivalent costs from primary and hospital-based models of care in the community.

Results: The total non-drug cost accumulated by prisoners in the SHP was AUD$749,470 (uncertainty range: AUD$728,905-794,111). 659/803 were PCR positive, 424/659 had sentences long enough to be eligible for treatment, and 416/424 were initiated on treatment, resulting in an average non-drug cost of AUD$1,802 (95% CI: AUD$1799-1841) per prisoner initiated. A protocol change allowing prisoners with short sentences to start treatment reduced the average non-drug cost to AUD$1263 (95% CI: AUD$1263-1287) per prisoner initiating treatment - 11% and 56% cheaper than estimated equivalent costs in primary (AUD$1654) and hospital-based (AUD$2847) models of care in the community, respectively.

Conclusion: Delivering hepatitis C treatment in prison using a nurse-led model of care is cheaper than delivering treatment in the community. These findings provide an economic rationale for implementing coordinated prison-based hepatitis C treatment programs.

Keywords: Cost; Direct-acting antivirals; Hepatitis C; Nurse-led care; Prison.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Antiviral Agents / therapeutic use
Cost-Benefit Analysis
Hepatitis C* / drug therapy
Hepatitis C, Chronic* / drug therapy
Humans
Nurse's Role
Prisoners*
Prisons
Victoria

Substances

Antiviral Agents