Table 5.

Cost-Effectiveness of Treating All Patients Versus Delaying Treatment to Later Fibrosis Stage or to Later Diagnosis and Fibrosis Stage: Incarcerated Individuals

Reference	Country	Genotype	Analysis		Model Features			Population			LMIC	Newest Drug(s)	Comparator(s)	ICER ($/QALY Gained)	Currency (Year)	Notes
			Fibrosis Stratified	Delay Considered	Model Typea	Transmission	Reinfection	PWID Focus	Incarcerated	Highly Stratified
He, 201666	US	1, 2, 3, 4	Yes	Yes	AB	Yes	Yes	Yes	Yes	No	No	10-year opt-out screening of incoming inmates with new DAA treatment	Risk-based screening or opt-out screening for shorter time periods	Treatment of ≥F3: 29,234 Treatment ≥F0: <50,000	US$ (2014)	The main analysis focuses on treatment access for ≥F3 but sensitivity analyses show that expanded sustained screening followed by treatment regardless of fibrosis stage also costs <$50,000 per QALY gained.
Liu, 201467	US	1	Yes	Implicit	M	No	Yes	No	Yes	No	No	SOF-PGN and ribavirin treatment while incarcerated	No therapy or older therapies while incarcerated	<30,000	US$ (2013)	Exact ICER depended on length of incarceration. Delay is implicit if lower screening rates imply later detection (and hence more advanced fibrosis progression).
Martin, 201665	UK	1, 2, 3, 4	Yes	Implicit	DT	Yes	Yes	Yes	Yes	No	No	Double testing rates and provide all-oral DAA in prison	Status quo	15,090	£ (2014)	Delay is implicit if lower screening rates imply later detection (and hence more advanced fibrosis progression).

DAA, direct-acting antiviral; F0, F1, F2, F3, F4, indicates severity of patient’s liver disease using metavir fibrosis scale (“≥F2” indicates all patients with at least F2 fibrosis which is F2, F3, and F4); ICER, incremental cost-effectiveness ratio; LMIC, low- and middle-income countries; PWID, people who inject drugs; QALY, quality-adjusted life year; SOF, sofosbuvir.

^a.Model type: M, Markov model; DT, dynamic transmission model; MS, microsimulation; AB, agent-based simulation.