Hepatitis C in a prison in the North East of England: What is the economic impact of the universal offer of testing and emergent medications?

Background: Over 90% of new hepatitis C virus (HCV) infections occur in people who inject drugs (PWIDs) and ∼60% of PWIDs have been in prescribed places of detention (PPDs). In 2013, Public Health England, NHS England (NHSE) and the National Offender Management Service published guidance on universal HCV testing for PPDs. Recent National Institute of Health and Care Excellence (NICE) guidance has recommended sofosbuvir for the treatment of genotype 1 disease, with further guidance expected for ledipasvir-sofosbuvir for the treatment of genotype 1 and 3 disease. Methods: Health-care representatives from Northumberland prison provided data on HCV testing and treatment for 2013-14. Economic modelling of current screening and treatment arrangements and future predicted costs (based on the universal offer of testing and new treatments recently approved by NICE) was then undertaken. Results: The results of economic modelling suggest that current annual HCV costs at Northumberland prison are around £300 675, but that costs could escalate to £1 625 794 with a 70% uptake of the universal offer of testing, and consideration given to the higher costs associated with treatments approved by NICE. Conclusions: This study demonstrates that costs associated with changes to testing and treating HCV in PPDs have the potential to increase significantly for commissioners of prison health-care services, and those funding medication.