ArticleThe Lancet regional health. Western Pacific2026
Mass hepatitis C virus screening among persons in custody in Hong Kong: a modelling cost-effectiveness analysis based on a prospective cohort study.
Article in The Lancet regional health. Western Pacific, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Background: Persons in custody (PICs) have a disproportionately high rate of hepatitis C virus (HCV) infection, yet correctional elimination programmes remain scarce. We evaluated the cost-effectiveness of different prison-targeted tailored strategies. Methods: Using prison-based cohort data, we modelled 10,000 PICs via a decision tree and age-stratified Markov framework to compare one-off screening or periodic screening, against no screening. Each ran under hepatologist-led teleconsultation, outreach face-to-face consultation (on-site visits) and hospital-based consultation. Costs and quality-adjusted life years (QALYs) were estimated from a societal perspective, with incremental cost-effectiveness ratios (ICERs) benchmarked to the per-capita GDP (USD 54,134). Findings: Compared with no screening, one-off screening strategies reduced HCV-related compensated cirrhosis by 0.4-5.0%, decompensated cirrhosis by 0.6-6.8%, hepatocellular carcinoma by 0.4-5.2%, and HCV-related mortality by 0.4-3.7%. Mean costs increased from US $1326 to US $1375 and QALYs from 7.536 to 7.554 per person. ICERs for one-off strategies ranged from US $2680 to 2920 per QALY. Triennial and annual screening yielded higher health gains but with higher ICERs of US $7837 and 15,370 per QALY. Results were robust across care delivery models, prevalence scenarios, and sensitivity analyses. Interpretation: Prison-based HCV screening with one-time screening strategies is cost-effective in a metropolitan setting. Periodic screening can further reduce disease burden but requires a higher commitment of the healthcare budget. Integration of telemedicine-supported, prison-based screening within the national hepatitis elimination strategy could accelerate HCV micro-elimination and deliver a substantial public health impact. Funding: Health Bureau, Government of HKSAR under Health and Medical Research Fund (reference: 20211881).
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