Hepatitis C Behind Bars May Be Too Costly to Cure

A study of Rhode Island state prisons shines a spotlight on the trouble correctional facilities face because they aren’t financially equipped to bear the budget-busting costs of new drugs to treat all inmates chronically infected with hepatitis C, according to an article in the Journal of Urban Health.

A study conducted by John Nguyen, a former graduate student in public health at Brown University, looked at the prison population within the Rhode Island Department of Corrections. Nguyen and fellow researchers reviewed both electronic and paper medical records to estimate a 17% prevalence of chronic hepatitis C infection among the inmate population there, a percentage estimate reflected in other state prison systems, according to a Brown University news release.

The goal of the study was to analyze the budget impact of the treatment costs for hepatitis C in a state correctional population. The analysis compared three different treatment strategies; all patients who were chronically infected, only patients with demonstrated fibrosis and only patients with advanced fibrosis.

Chronic infection of the bloodborne hepatitis C virus can severely damage the liver over time. If left untreated, the disease can lead to cirrhosis, liver cancer, and possibly the need for a liver transplant.

People can live for years with hepatitis C and never know they have it because they may lack symptoms. The launching of an awareness campaign by health officials to encourage baby boomers to get tested for the virus has coincided in the last couple of years with approval and marketing of new drugs that are less toxic than previous treatments and have high cure rates, as well as big price tags.

By law, correctional facilities must provide inmates the same level of medical treatment they would receive outside prison walls. In 2014, Rhode Island’s prison system budgeted $19.9 million for health overall, and $2.7 million for pharmaceuticals, according to the release from Brown University, which took part in the study.

Researchers determined that it would cost roughly $34 million to treat all inmates who had at least six months remaining in their sentence. That amount is 13 times the pharmacy budget and nearly twice as much as the overall healthcare budget, according to the study abstract. A more conservative approach that would treat just the sickest of patients infected with the virus would cost more than $15 million and exceed the state prison system’s pharmacy budget six times over.

“The big problem is, even if you just take the most advanced disease, you can’t afford it with the current correctional budget,” said Brian Montague, a Brown University assistant professor of medicine and health services, physician in the Division of Infectious Disease at Providence-based Miriam Hospital, and one of the study authors. “There was an option to defer treatment before because the [prior] treatments were significantly more toxic and the risks often outweighed the benefits. Now, with safe and highly effective treatments, morally and ethically there’s no option to not treat, particularly for those with more advanced disease.”

The authors recommend that drug costs be reexamined in an effort to make treatment more accessible and equitable now that cure rates for the disease have improved.

“With immense costs projected with new treatment, it is unlikely that correctional facilities will have the capacity to treat all those afflicted” with the hepatitis C virus, states the study abstract. “Alternative payment strategies in collaboration with outside programs may be necessary to curb this epidemic.”