Sofosbuvir-Based Triple Therapy for HCV-Infected Prisoners

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.