Disease Elimination Program, Burnet Institute, Melbourne, Victoria, Australia.
Department of Gastroenterology, St Vincent's Hospital Melbourne, Fitzroy, Victoria, Australia; Department of Medicine, The University of Melbourne, Parkville, Victoria, Australia.
Int J Drug Policy. 2021 Aug;94:103203. doi: 10.1016/j.drugpo.2021.103203. Epub 2021 Mar 18.
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.
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.
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.
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.
丙型肝炎在囚犯中高度流行。直接作用抗病毒药物 (DAA) 治疗丙型肝炎的简单性使得有可能利用新的护理模式在监狱内增加治疗的接受率。我们使用澳大利亚维多利亚州全州肝炎计划 (SHP) 的真实世界数据来估计使用该计划为囚犯开始治疗的平均非药物成本 - 一种协调的护士主导的护理模式。
数据来自于 2015 年 11 月至 2016 年 12 月期间在 SHP 就诊的囚犯（抗体阳性诊断后）。估计了与 SHP 相关的所有成本，包括人员工资、医学检查、药房成本和管理费用。排除了 DAA 成本，因为在澳大利亚，药物数量不受限制，由联邦政府与制药公司的风险分担协议覆盖。通过 SHP 开始治疗的平均非药物成本与社区中初级和医院为基础的护理模式的等效成本进行了比较。
SHP 中囚犯的总非药物费用为 749,470 澳元（不确定性范围：728,905-794,111 澳元）。659/803 人 PCR 阳性，424/659 人的刑期足够长，有资格接受治疗，416/424 人开始接受治疗，导致每名开始治疗的囚犯的平均非药物成本为 1,802 澳元（95%CI：1799-1841 澳元）。允许刑期较短的囚犯开始治疗的方案变更将每名开始治疗的囚犯的平均非药物成本降低至 1263 澳元（95%CI：1263-1287 澳元）- 比社区中初级（1654 澳元）和医院为基础（1654 澳元）护理模式的估计等效成本分别便宜 11%和 56%。
使用护士主导的护理模式在监狱内提供丙型肝炎治疗比在社区内提供治疗更便宜。这些发现为实施协调的监狱内丙型肝炎治疗计划提供了经济依据。
