クイーンズランド州の地域矯正医療におけるC型肝炎スクリーニングプログラムの費用分析

People involved with the criminal justice system typically have lower healthcare engagement and higher risk of hepatitis C virus (HCV) infection than the general population. Interventions run at community corrections centres have the potential to diagnose and treat previously unreached populations. This study aimed to estimate the cost per treatment initiation and cost per cure through HCV programs at community corrections centres.

Data were obtained over the period of July 2022 to July 2023 from screening clinics run by Hepatitis Queensland in four community corrections centres located in Brisbane, Australia. All non-drugcosts (presented in 2023 A$ without discounting) were included from the perspective of the clinics, including staff salaries, general practitioner (GP) fees, logistics, medical testing, incentives and overhead costs. Costs of follow up instances were estimated from total nurse follow-up time per clinic.

The total non-drug cost accumulated over 33 clinics in the 13-month study period was $159,982. Among the 185 participants, 23 tested RNA positive (12%). At the end of the study period 8 participants had achieved sustained virologic response (SVR) and 6 were still on treatment. This resulted in a cost per cure of $19,998 or $11,427 per patient initiated on treatment. If GP costs were excluded (i.e. paid by Medicare and not the clinic) the cost per cure and cost per treatment initiation were $12,843 and $7,339 respectively.

As overall prevalence decreases and case finding becomes a greater challenge, providing HCV testing and treatment through community correctional centres may be a cost-effective way of reaching people living with HCV not engaged with healthcare.