Sofosbuvir-Based Triple Therapy for HCV-Infected Prisoners

Summary and Comment |
November 14, 2014

Sofosbuvir-Based Triple Therapy for HCV-Infected Prisoners

  1. Atif Zaman, MD, MPH

In modeling scenarios, this regimen's cost-effectiveness was high but dependent on low reinfection rates.

  1. Atif Zaman, MD, MPH

Chronic hepatitis C virus (HCV) infection prevalence is as high as 35% in U.S. prison populations. Although compliance to treatment is typically not a concern in incarcerated patients, reinfection and incomplete treatment in patients with short prison sentences are real concerns.

To determine whether a 12-week course of a sofosbuvir-based regimen is cost-effective in treating HCV-infected incarcerated patients, researchers constructed a Markov model using data from a cohort of incarcerated, treatment-naive men aged 40 years with genotype 1 HCV infection. The model took into account aspects unique to this population, including risk for reinfection after initial eradication.

Treatment strategies included no treatment, a two-drug regimen (peginterferon plus ribavirin), and three-drug regimens (boceprevir-based and sofosbuvir-based) and yielded 13.12, 13.57, 14.43, and 15.18 quality-adjusted life-years (QALYs) gained, respectively. Absolute reductions in decompensated cirrhosis and hepatocellular carcinoma were greatest with the sofosbuvir-based regimen (16% and 9%, respectively). Although the sofosbuvir-based regimen increased total expected cost per person by >US$54,000, the cost per QALY gained was <US$30,000, and the 12-week course allowed inmates with short sentences to be treated without disruption. Reinfection rates would need to be higher than 0.18 per person-year for the cost per QALY gained to exceed US$100,000.

Comment

In this model simulation, compared with no treatment, a three-drug, sofosbuvir-based regimen was cost-effective in treating incarcerated patients with genotype 1 HCV infection. Also, the short duration of this regimen allowed inmates with short sentences to get treatment without interruption. However, analysis did reveal that its cost-effectiveness dropped with higher rates of reinfection, which is a particular concern in this population.

Editor Disclosures at Time of Publication

  • Disclosures for Atif Zaman, MD, MPH at time of publication Nothing to disclose

Citation(s):

Your Comment

(will not be published)

Filtered HTML

  • Allowed HTML tags: <a> <em> <strong> <cite> <blockquote> <code> <ul> <ol> <li> <dl> <dt> <dd>
  • Web page addresses and e-mail addresses turn into links automatically.
  • Lines and paragraphs break automatically.

Plain text

  • No HTML tags allowed.
  • Web page addresses and e-mail addresses turn into links automatically.
  • Lines and paragraphs break automatically.
Do you have any conflict of interest to disclose?
CAPTCHA
This question is for testing whether you are a human visitor and to prevent automated spam submissions.

Vertical Tabs

* Required

Reader comments are intended to encourage lively discussion of clinical topics with your peers in the medical community. We ask that you keep your remarks to a reasonable length, and we reserve the right to withhold publication of remarks that do not meet this standard.

PRIVACY: We will not use your email address, submitted for a comment, for any other purpose nor sell, rent, or share your e-mail address with any third parties. Please see our Privacy Policy.