title: Sofosbuvir-based treatment regimens for chronic, genotype 1 hepatitis C virus infection in U.S. incarcerated populations: a cost-effectiveness analysis.
abstract: 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.
  
  
  METHODS
  Markov model.
  
  
  METHODS
  Published literature and expert opinion.
  
  
  METHODS
  Treatment-naive men with chronic, genotype 1 HCV monoinfection.
  
  
  METHODS
  Lifetime.
  
  
  CONCLUSIONS
  Societal.
  
  
  METHODS
  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.
  
  
  METHODS
  Discounted costs (in 2013 U.S. dollars), discounted quality-adjusted life-years (QALYs), and incremental cost-effectiveness ratios.
  
  
  RESULTS
  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
  High reinfection rates in prison attenuated cost-effectiveness for persons with long sentences.
  
  
  CONCLUSIONS
  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.
  
  
  CONCLUSIONS
  Sofosbuvir-based treatment is cost-effective for incarcerated persons, but affordability is an important consideration.
  
  
  BACKGROUND
  National Institutes of Health.
authors.forename: Shan
authors.initials: S
authors.lastname: Liu
authors.forename: Daena
authors.initials: D
authors.lastname: Watcha
authors.forename: Mark
authors.initials: M
authors.lastname: Holodniy
authors.forename: Jeremy D
authors.initials: JD
authors.lastname: Goldhaber-Fiebert
mesh_terms: D000328:Adult; D000998:Antiviral Agents / Q000191:economics / Q000627:therapeutic use*; D003362:Cost-Benefit Analysis; D016527:Drug Costs; D004359:Drug Therapy, Combination; D016174:Hepacivirus / Q000235:genetics; D019698:Hepatitis C, Chronic / Q000188:drug therapy*; D006801:Humans; D016898:Interferon-alpha / Q000627:therapeutic use; D008297:Male; D011092:Polyethylene Glycols / Q000627:therapeutic use; D011329:Prisoners; D011392:Proline / Q000031:analogs & derivatives / Q000627:therapeutic use; D019057:Quality-Adjusted Life Years; D012254:Ribavirin / Q000627:therapeutic use; D000069474:Sofosbuvir; D014481:United States; D014542:Uridine Monophosphate / Q000031:analogs & derivatives* / Q000191:economics / Q000627:therapeutic use
chemical_list: D000998:Antiviral Agents; D016898:Interferon-alpha; D011092:Polyethylene Glycols; D012254:Ribavirin; C512204: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; D011392:Proline; D014542:Uridine Monophosphate; D000069474:Sofosbuvir