Hong Kong model finds prison HCV screening cost-effective

In 2023, eligible people in custody in Hong Kong were offered voluntary screening and treatment for hepatitis C virus (HCV), an infection that may progress to cirrhosis, liver cancer or death. The pilot became the foundation for a larger question: whether finding infections early across correctional settings would be worth the cost. A University of Hong Kong team now says its analysis finds that it is.

The pilot found HCV prevalence of 4.1% among people in custody, compared with 0.3% in Hong Kong's general population. That gap gives screening a practical target: identify infections before symptoms force people into care. The research team reported a 100% success rate in linking participants to care and achieving viral eradication with support from the team.

For the economic analysis, researchers simulated a cohort of 10,000 people in custody using a decision tree and a Markov model, which follows how health states change over time. The comparison was no screening, a situation in which diagnoses typically occur only after advanced clinical symptoms appear. One-time universal screening of current people in custody, new admissions or both was projected to be highly cost-effective and to lower the risk of advanced liver disease by more than 30%.

The model points to a shift in how resources are used: away from treating complications such as liver cancer and toward earlier diagnosis and treatment. Teleconsultation—specialist care delivered remotely—also emerged as a cost-efficient, scalable option for people in custody, potentially reducing reliance on face-to-face outpatient or hospital consultations.

So what changes in practice? Hong Kong has evidence to support systematic HCV screening in correctional settings, especially where prevalence is moderate to high and health-care resources are adequate. The study can inform strategies under the Hong Kong Viral Hepatitis Action Plan 2025–2030, but its disease and cost results are projections from a model, not proof that a territory-wide program is already operating. The broader goal is to help close a diagnostic gap: by 2024, only 36% of people living with HCV had been diagnosed and 20% had received curative treatment.