A University of Hong Kong analysis shows one-off hepatitis C virus (HCV) screening of persons in custody (PICs) to be cost-effective and reduce the rates of HCV-related compensated and decompensated cirrhosis (DC), hepatocellular carcinoma (HCC), and HCV-related mortality.
The high concentration of people who inject drugs (PWID) within correctional institutions, driven by the criminalization of illicit substances, amplifies HCV prevalence among PICs. [Lancet 2016;388:1115-1126] Thus, targeted screening and linkage-to-care in correctional institutions could deliver disproportionate benefits.
“Our group has initiated a government-funded programme in one of Hong Kong’s correctional institutions to implement HCV screening and linkage-to-care, generating robust prevalence data and assessing the feasibility of a prison-based micro-elimination strategy,” wrote the researchers. [J Hepatol 2025;82:S845] “Building on these findings, we modelled the cost-effectiveness of mass HCV screening in Hong Kong prisons to inform policies on elimination in correctional institutions.”
Using prison-based cohort data, the researchers modelled 10,000 PICs and compared no screening vs five screening strategies: 1) one-off screening of new entrants, in which all incoming prisoners were tested upon admission; 2) one-off screening of existing prisoners, involving a single round of testing for all currently incarcerated individuals; 3) combined one-off screening, covering all existing prisoners once and all new entrants at the time of admission; 4) repeat screening conducted every 3 years; and 5) annual repeat screening. [Lancet Reg Health West Pac 2026;69:101838]
The analysis was conducted from a societal perspective, incorporating direct medical, direct non-medical, and indirect costs, including diagnostic testing, antiviral therapy, consultations delivered via teleconsultation, physical outreach, and hospital-based services, and long-term disease management.
Relative to no screening, one-off combined screening was projected to reduce the incidence of compensated cirrhosis by 5.0 percent, DC by 6.8 percent, and HCC by 5.2 percent, with a 3.7 percent decline in HCV-related mortality.
In the base-case analysis using the teleconsultation model, one-off HCV screening strategies substantially improved health outcomes at modest incremental cost vs no screening. The average cost per person increased slightly from USD 1,326 under no screening to about USD 1,375 with one-off combined screening, while quality-adjusted life years (QALYs) per person rose from 7.536 to 7.554.
Across the three one-off strategies, screening of existing inmates showed the lowest incremental cost-effectiveness ratio (ICER) of USD 2,680. Although triennial and annual screening yielded incremental gains in health benefits, their ICERs increased substantially to USD 7,837 and USD 15,370 per QALY, respectively, indicating reduced cost-effectiveness vs one-off screening.
In scenario analyses, both the physical outreach and hospital-based models showed progressively higher per-person and total incremental costs vs the teleconsultation model, as HCV prevalence increased. “In our analysis, teleconsultation leveraged specialist hepatology expertise without the logistical and security burdens associated with in-person outreach. It emerged as a cost-efficient and scalable model, which maintained clinical quality while reducing manpower and transport costs,” explained the researchers.
“In conclusion, one-off universal screening of all PICs in Hong Kong was found to be cost-effective for HCV elimination in correctional institutions, achieving health gains at modest incremental cost vs no screening. This approach enabled earlier diagnosis and treatment, reduced projected HCC incidence, and shifted health expenditures from end-stage disease management to curative therapy,” summarized the researchers.