Hepatitis C virus (HCV)
infection continues to disproportionately affect incarcerated populations. New HCV
drugs present opportunities and challenges to address HCV in corrections.
The
goal of this study was to evaluate the impact of the treatment costs for HCV
infection in a state correctional population through a budget impact analysis
comparing differing treatment strategies. Electronic and paper medical records
were reviewed to estimate the prevalence of hepatitis C within the Rhode Island
Department of Corrections.
Three treatment strategies were evaluated as
follows:
- treating all chronically infected persons,
- treating only patients with demonstrated fibrosis, and
- treating only patients with advanced fibrosis.
Budget impact was computed as the percentage of pharmacy and
overall healthcare expenditures accrued by total drug costs assuming entirely
interferon-free therapy. Sensitivity analyses assessed potential variance in
costs related to variability in HCV prevalence, genotype, estimated variation
in market pricing, length of stay for the sentenced population, and uptake of
newly available regimens.
Chronic HCV prevalence was estimated at 17% of the
total population. Treating all sentenced inmates with at least 6 months
remaining of their sentence would cost about $34 million-13 times the pharmacy
budget and almost twice the overall healthcare budget. Treating inmates with
advanced fibrosis would cost about $15 million. A hypothetical 50% reduction in
total drug costs for future therapies could cost $17 million to treat all
eligible inmates.
With immense costs projected with new treatment, it is
unlikely that correctional facilities will have the capacity to treat all those
afflicted with HCV. Alternative payment strategies in collaboration with
outside programs may be necessary to curb this epidemic. In order to improve
care and treatment delivery, drug costs also need to be seriously reevaluated
to be more accessible and equitable now that HCV is more curable.
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By:
- 1Brown University School of Public Health, Providence, RI, USA.
- J Urban Health. 2015 Aug;92(4):635-49. doi: 10.1007/s11524-015-9953-4.
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