BACKGROUND Hepatitis C virus (HCV) testing and treatment uptake in prisons remains low. We aimed to estimate clinical outcomes, cost-effectiveness (CE), and budgetary impact (BI) of HCV testing and treatment in United States (U.S.) prisons or linkage to care at release. METHODS We used individual-based simulation modeling with healthcare and Department of Corrections (DOC) perspectives for CE and BI analyses, respectively. We simulated a U.S. prison cohort at entry using published data and Washington State DOC individual-level data. We considered permutations of testing (risk factor-based, routine at entry or at release, no testing), treatment (if liver fibrosis ≥F3, for all HCV-infected or no treatment) and linkage to care (at release or no linkage). Outcomes included quality adjusted life years (QALY); cases identified, treated and cured; cirrhosis cases avoided; incremental cost-effectiveness ratios (ICER); DOC costs (2016 US $); and BI (healthcare cost/prison entrant) to generalize to other states. RESULTS Compared to "no testing, no treatment and no linkage to care", "test all, treat all, and linkage to care at release" increased the lifetime sustained virologic response by 23%, reduced cirrhosis cases by 54% at a DOC annual additional cost of $1,440/ prison entrant, and would be cost-effective. At current drug prices, targeted testing and liver fibrosis-based treatment provided worse outcomes at higher cost or worse outcomes at higher cost/QALY gained. In sensitivity analysis, fibrosis-based treatment restrictions were cost-effective at previous higher drug costs. CONCLUSIONS Although costly, widespread testing and treatment in prisons are considered of good value at current drug prices.

中文翻译：

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美国监狱中丙型肝炎病毒检测、治疗和护理联系的成本效益和预算影响。

背景技术监狱中丙型肝炎病毒 (HCV) 检测和治疗的使用率仍然很低。我们旨在评估美国 (US) 监狱中 HCV 检测和治疗的临床结果、成本效益 (CE) 和预算影响 (BI)，或与释放时护理的联系。方法 我们分别使用基于个人的模拟建模与医疗保健和惩教部 (DOC) 的视角进行 CE 和 BI 分析。我们使用已发布的数据和华盛顿州 DOC 个人级别的数据模拟了一个美国监狱队列。我们考虑了检测的排列（基于风险因素、入院或出院时常规、无检测）、治疗（如果肝纤维化≥F3，对于所有 HCV 感染或未治疗）以及与护理的联系（出院或无联系） . 结果包括质量调整生命年（QALY）；发现、治疗和治愈的病例；避免肝硬化病例；增量成本效益比（ICER）；DOC 费用（2016 美元）；和 BI（医疗保健费用/入狱人数）推广到其他州。结果 与“无检测、无治疗、无护理联系”相比，“检测全部、全部治疗、出院时与护理联系”使终生持续病毒学应答增加 23%，每年 DOC 时肝硬化病例减少 54% 1,440 美元/入狱者的额外费用，并且具有成本效益。在目前的药品价格下，靶向检测和基于肝纤维化的治疗以更高的成本提供更差的结果，或者以更高的成本/QALY 获得更差的结果。在敏感性分析中，基于纤维化的治疗限制在以前较高的药物成本下具有成本效益。结论 虽然代价高昂，