JAMA Internal Medicine | Health Benefits, Costs, and Cost-Effectiveness of Jail-Based Hepatitis C Elimination Strategies
JAMA Internal Medicine | Health Benefits, Costs, and Cost-Effectiveness of Jail-Based Hepatitis C Elimination Strategies
Lin Zhu, Lora N. Magaldi, Indrani A. Wagh, et al
DOI: 10.1001/jamainternmed.2026.0190
Background
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.
Methods
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. Jail-based HCV interventions comprised varying combinations of testing at entry, treatment in jail, and HCV navigation services on release. Main outcomes included changes in person-years of HCV infection, incidence, HCV-related mortality, cumulative quality-adjusted life-years (QALYs), health care costs over 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 over 60 years. The combined strategy of testing, treatment, and navigation reduced cumulative person-years of infection, incidence, and HCV-related deaths 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 intervention, well below commonly used cost-effectiveness thresholds ($50 000–$150 000 per QALY). Providing treatment in jails in addition to testing was cost-saving or yielded lower ICERs than testing alone, and strategies including navigation had lower ICERs. Results were robust to variations in key parameters.
Fig. 1 Bar Graph of the Impact of Jail-Based Hepatitis C Virus (HCV) Interventions on HCV Infection
Fig. 2 Cost-Effectiveness Plane of Jail-Based Hepatitis C Virus (HCV) Interventions
Fig. 3 Tornado Graph of the Impact of Variations to Key Parameters on the Cost-Effectiveness of Jail-Based Hepatitis C Virus (HCV) Interventions
Conclusion
Jail-based HCV elimination interventions, particularly those including treatment during detention, reduced prevalent and incident HCV cases and HCV-related deaths among people who inject drugs both within and beyond jail settings, and represent a cost-effective strategy for public health decision-makers.
Reference
Zhu L, Magaldi LN, Wagh IA, et al. Health Benefits, Costs, and Cost-Effectiveness of Jail-Based Hepatitis C Elimination Strategies. JAMA Intern Med. Published online March 23, 2026. doi:10.1001/jamainternmed.2026.0190
