Health Benefits, Costs, and Cost-Effectiveness of Jail-Based Hepatitis C Elimination Strategies.

Importance: Injection drug use is a major risk factor for both hepatitis C virus (HCV) infection and incarceration. The high volume and rapid turnover of individuals in jails make this setting a critical access point for hepatitis C elimination among people who inject drugs, with potential downstream benefits for reducing community transmission. Objective: To evaluate the health benefits, costs, and cost-effectiveness of jail-based HCV interventions. Design, Setting, and Participants: This cost-effectiveness analysis extended a dynamic network simulation model of HCV transmission through injection equipment sharing among people who inject drugs to incorporate population transitions between jails and communities. Data on justice-involved individuals from the Philadelphia FIGHT program and published literature on people who inject drugs in urban settings in the US were used to model an urban correctional and community setting. Analyses were conducted between April 2024 and February 2026. Interventions: Jail-based HCV interventions comprising varying combinations of testing at entry, treatment in jail, and HCV navigation services on release. Main Outcomes and Measures: Changes in person-years of HCV infection, incidence of HCV infection, HCV-related mortality, cumulative quality-adjusted life-years (QALYs), and health care costs across 60 years, and incremental cost-effectiveness ratios (ICERs). Results: The mean initial age of 1552 simulated people who inject drugs was 32 years. Without jail-based interventions, there were 21 349 person-years of infection, 662 incident infections, and 240 HCV-related deaths per 1000 people who inject drugs over the 60-year time horizon. The combined strategy of testing and treatment plus navigation reduced the cumulative person-years of infection, incidence, and HCV-related deaths in the simulated population by 35% (95% UI, 30%-39%), 47% (95% UI, 41%-54%), and 40% (95% UI, 31%-49%), respectively. The ICER of this strategy was $11 000 per QALY gained compared with no jail-based intervention, well below typical standards for benchmarking cost-effectiveness, which often use thresholds ranging from $50 000 to $150 000 per QALY gained. Providing treatment in jails in addition to testing was cost-saving or yielded lower ICERs compared with providing only testing. Strategies that incorporated navigation yielded lower ICERs than strategies that did not. The results were robust to variations in key parameter values. Conclusions and Relevance: In this cost-effectiveness analysis using a network simulation model, jail-based HCV elimination interventions, particularly those providing treatment during detention, reduced prevalent and incident HCV cases and HCV-related deaths among people who inject drugs both within and beyond jails. These interventions are a cost-effective strategy for public health decision-makers to consider.