Open forum infectious diseases · 2026
A Costing Analysis of a Nurse- and Peer-Led Mobile Model of Hepatitis C Care Adjacent to the Community Corrections Setting.
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Griffin Samara, Houdroge Farah, Scott Nick, Reid Bridget, Maynard Kelly, Pappas Alex, Craigie Anne, Belzer Mark, Dicka Jane, Holmes Jacinta A, Thompson Alexander J, Stoove Mark, Winter Rebecca
Аннотация
BACKGROUND: Prison-based hepatitis C models of care treat significant numbers of people in Australia but exclude most of the criminal justice system, individuals serving their sentence in the community, on community corrections orders. We estimate the cost of a nurse- and peer-led model of hepatitis C care, offering hepatitis C virus (HCV) point-of-care testing and treatment initiation, adjacent to the community corrections setting in Melbourne, Australia.
METHODS: Data from September 2023 to March 2025 for the C No More program were incorporated. All costs were estimated from a service provider perspective, including clinic infrastructure, staff wages, testing, incentive, and pharmacy costs. Treatment and pretreatment pathology costs were excluded as these are covered by the Australian government. Total program cost, mean cost per individual initiated on treatment, and mean cost per individual that achieved sustained virological response were calculated.
RESULTS: The total cost of the C No More service between September 2023 and March 2025 was A$312 166.85 (costs are presented in 2024 Australian dollars). Among 832 participants, 592 were HCV antibody tested, 275 were HCV RNA tested, 61 were HCV RNA positive, 58 initiated treatment, and 41 achieved sustained virological response. The cost per participant initiating treatment was A$5382.19, and the cost per participant cured was A$7613.83. HCV RNA-negative participants (n = 771 [93%]) contributed to 84% of total program costs (A$263 490.72).
CONCLUSIONS: Providing effective hepatitis C care in the community requires a low-threshold, supportive model of care with intensive follow-up and retention in care strategies. Service costs reflect increased case finding challenges, in the context of declining community HCV RNA prevalence.
METHODS: Data from September 2023 to March 2025 for the C No More program were incorporated. All costs were estimated from a service provider perspective, including clinic infrastructure, staff wages, testing, incentive, and pharmacy costs. Treatment and pretreatment pathology costs were excluded as these are covered by the Australian government. Total program cost, mean cost per individual initiated on treatment, and mean cost per individual that achieved sustained virological response were calculated.
RESULTS: The total cost of the C No More service between September 2023 and March 2025 was A$312 166.85 (costs are presented in 2024 Australian dollars). Among 832 participants, 592 were HCV antibody tested, 275 were HCV RNA tested, 61 were HCV RNA positive, 58 initiated treatment, and 41 achieved sustained virological response. The cost per participant initiating treatment was A$5382.19, and the cost per participant cured was A$7613.83. HCV RNA-negative participants (n = 771 [93%]) contributed to 84% of total program costs (A$263 490.72).
CONCLUSIONS: Providing effective hepatitis C care in the community requires a low-threshold, supportive model of care with intensive follow-up and retention in care strategies. Service costs reflect increased case finding challenges, in the context of declining community HCV RNA prevalence.