Date of download: 6/1/2016 From: Prevention of Hepatitis C by Screening and Treatment in U.S. Prisons Ann Intern Med. 2016;164(2):84-92. doi:10.7326/M15-0617.

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Date of download: 6/1/2016 From: Prevention of Hepatitis C by Screening and Treatment in U.S. Prisons Ann Intern Med. 2016;164(2): doi: /M Model schematic of HCV transmission and progression in prisons and in the general population. The schematic of our agent-based model shows the prison population and general population and the dynamic movement between the 2 groups (dashed arrows). Each person is defined by demographic characteristics, liver stage, and IDU. As time progresses, the following characteristics are updated: age, IDU status, HCV infection status (infected individuals shown in black), stage of liver disease, and location (inside or outside prison). HCV-infected persons can transmit disease to others in their immediate network (solid arrows). The natural history of chronic HCV disease is represented by Markov states (top right inset). Stages of chronic HCV disease are defined by METAVIR fibrosis scores. Advanced liver diseases stages are DC, HCC, LT, and LRDs. DC = decompensated cirrhosis; F0 = no fibrosis; F1 = portal fibrosis without septa; F2 = portal fibrosis with few septa; F3 = numerous septa without cirrhosis; F4 = compensated cirrhosis; HCC = hepatocellular carcinoma; HCV = hepatitis C virus; IDU = injection drug use; LRD = liver-related death; LT = liver transplantation. Figure Legend: Copyright © American College of Physicians. All rights reserved.American College of Physicians

Date of download: 6/1/2016 From: Prevention of Hepatitis C by Screening and Treatment in U.S. Prisons Ann Intern Med. 2016;164(2): doi: /M Projected reduction of HCV transmission and HCV-associated costs. 1Yr-Risk = 1-time risk-based screening of currently incarcerated and entrants with active or former injection drug use for 1 y; 1Yr-All = 1-time opt-out screening of currently incarcerated inmates and entrants for 1 y; 5Yr- All = 1-time opt-out screening of currently incarcerated inmates and entrants for 5 y; 10Yr-All = 1-time opt-out screening of currently incarcerated inmates and entrants for 10 y; HCV = hepatitis C virus; No screening = no screening inside prisons. Top. Projected reduction of new infections over 30 y due to HCV screening of inmates compared with no screening. Screening of inmates reduces new infections both inside the prisons and in the general U.S. population (owing to the spread of infection via released inmates), and 89% to 92% of total reductions occur in the general population. Bottom. Cost of advanced HCV diseases averted because of screening of inmates in the next 30 y in prisons and in the general population. Compared with no screening, screening of inmates reduced costs of HCV disease by averting advanced stages of disease. Note that future cost savings from averted disease were discounted at 3% annually. Figure Legend: Copyright © American College of Physicians. All rights reserved.American College of Physicians

Date of download: 6/1/2016 From: Prevention of Hepatitis C by Screening and Treatment in U.S. Prisons Ann Intern Med. 2016;164(2): doi: /M Total cost of HCV screening and treatment in prisons, 2015–2029. Shown is the budget needed to screen, treat HCV infection, and manage chronic hepatitis C in prisons under 1-time opt-out universal screening of currently incarcerated inmates and entrants for 10 y (10Yr-All scenario). The annual budget decreased substantially from 2015 to 2029 because of a decrease in prevalence and discounting of future expenditures at 3% annually. HCV = hepatitis C virus. Figure Legend: Copyright © American College of Physicians. All rights reserved.American College of Physicians

Date of download: 6/1/2016 From: Prevention of Hepatitis C by Screening and Treatment in U.S. Prisons Ann Intern Med. 2016;164(2): doi: /M One-way sensitivity analysis showing the 15 most-sensitive parameters in cost-effectiveness analysis comparing the scenario with 1-time opt-out universal screening of currently incarcerated inmates and entrants for 10 y with a less-effective scenario. The black bars show the change in ICER from the base case, when the lower value of an input was used while all other input parameters were kept constant, and the gray bars show the change when the higher value was used. 10Yr-All = 1-time opt-out screening of currently incarcerated inmates and entrants for 10 y; AWP = average wholesale price; DC = decompensated cirrhosis; F0 = no fibrosis; F1 = portal fibrosis without septa; F2 = portal fibrosis with few septa; F3 = numerous septa without cirrhosis; F4 = compensated cirrhosis; HCC = hepatocellular carcinoma; HCV = hepatitis C virus; ICER = incremental cost-effectiveness ratio; QOL = quality of life; SVR = sustained viral response; TP = transition probability; WAC = wholesale acquisition cost. Figure Legend: Copyright © American College of Physicians. All rights reserved.American College of Physicians

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