A cost-effectiveness analysis of a multidisciplinary model of care on hepatitis C care among people released from provincial prison in Quebec, Canada

BACKGROUND: Many individuals are released from prison with untreated hepatitis C virus (HCV) and face challenges linking to care in the community. This study evaluated the cost-effectiveness of a multidisciplinary model of care compared to standard of care (SOC) across key steps along the HCV care cascade. METHODS: A prospective, pre-post study was conducted among men incarcerated in Quebec's largest provincial prison. Intervention participants received care from a nurse, social worker, and patient navigator before release and were offered appointment accompaniment post-release by the patient navigator. SOC participants were encouraged to undergo HCV screening and those with current HCV received a pre-release discharge HCV appointment. The analysis adopted a healthcare system perspective. The primary outcome was sustained virologic response (SVR) within 180 days post-release. Secondary outcomes included linkage to care within 90 days post-release, treatment initiation, and treatment completion. The incremental cost-effectiveness ratio (ICER) was calculated as the difference in costs (Canadian dollars, C$) divided by the difference in outcomes. RESULTS: Comparing 20 participants with current HCV infection (HCV RNA+) in both the intervention and the SOC arms, 16 vs. 12 were linked to care, 13 vs. 4 initiated treatment, 8 vs. 2 completed treatment, and 8 vs. 2 achieved SVR, respectively. The corresponding ICERs were C$1,242, C$10,481, C$25,577, and C$25,653 per additional person achieving the outcome. CONCLUSIONS: Our multidisciplinary model of care increased the proportion of HCV RNA+ people released from prison who subsequently achieved SVR, at an additional cost of C$25,653 per additional patient. This is only C$5,653 more than the estimated cost of direct-acting antivirals, providing an economic rationale for broader implementation.