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Modelling the Impact and Cost-Effectiveness of Extended Screening and Treatment with Direct-Acting Antivirals in a Swiss Custodial Setting.

Background
Hepatitis C virus (HCV) amongst people living in detention (PLD) is typically high in many countries including Switzerland, where it is estimated that the HCV prevalence rate is between 5.7% and 6.2%. In Switzerland, the existing screening strategy involves routine screening of PLD who indicate they are from HCV high-risk populations based on questionnaire responses upon entry to the detention center, rather than an offer to screen all PLD.


Methods
A cost-effectiveness analysis from a Swiss healthcare provider perspective was conducted by combining a five-year decision tree screening model with results from a Markov model of HCV treatment outcomes. This model explored the cost-effectiveness of increased HCV screening to cover all PLD compared to the current approach, using a standard test package and subsequent treatment with a single-tablet regimen in Swiss custodial settings. Sensitivity and scenario analyses examined the uncertainty of results.


Results
At the willingness to pay (WTP) threshold of 100,000 Swiss Francs (CHF) per quality-adjusted life year (QALY), comprehensive general screening was cost-effective compared to current risk-based screening, with a base case incremental cost-effectiveness ratio of CHF 14,312 per QALY. The net monetary benefit of screening the whole PLD population was CHF 23,298,046, and CHF 4,298 per person. The proportion of PLD tested was predicted to increase from 13.6% to 67.0% under comprehensive screening.


Conclusion
The results showed that comprehensive screening strategies in detention centres in Switzerland can be cost-effective, with the probabilistic sensitivity analysis estimating an 82.3% probability of cost-effectiveness.