Study Shows Treating HCV in Prisons with Pegylated Interferon Is Cost-Effective
by Matt Clarke
A new study published in the November 2008 issue of the medical journal Hepatology found that treating hepatitis C-infected prisoners with the standard therapy of pegylated interferon and ribavirin was cost-effective. Savings were as high as $41,321 per year, with 0.75 years of increased quality life expectancy for prisoners 40 to 49 years old without a pre-treatment biopsy.
Between 12 and 31 percent of the 2.3 million people incarcerated in U.S. prisons and jails are infected with the hepatitis C virus (HCV), which causes liver damage and eventual death if left untreated. This compares with a 1.3% infection rate in the general population.
The high rate of prisoner HCV infection is due to a high rate of intravenous drug use.
Annually, between 29% and 43% of the total number of HCV-infected persons in the U.S. pass through a prison or jail. Thus, the treatment of HCV-infected prisoners has wide-ranging consequences for our nation’s public health policy.
Previous studies had shown that the standard HCV treatment was cost-effective for the general U.S. population. This new study, led by Sammy Saab of the UCLA David Greffen School of Medicine, found that it was also cost-effective in the male prison population. The study used male prisoners because they exceed 87% of the U.S. prison population; the cost-effectiveness threshold was based on $50,000 per quality-adjusted year of life.
Prisoners often have medical complications, such as a high reinfection rate due to continued intravenous drug use and unsanitary tattoos, and a high mortality rate not related to liver disease. Current standards of treatment also vary within different prison and jail systems, with many requiring a liver biopsy showing liver fibrosis (advanced liver disease) and multiple years remaining on a prison sentence to qualify for any in-custody HCV treatment.
Most prisons and jails use a less-expensive and less-effective older treatment protocol for HCV that does not include pegylated interferon for those prisoners who qualify for treatment. This led researchers to expect that the standard treatment would not be cost-effective. Instead, they found “that treatment was cost-saving for prisoners of all age ranges and genotypes when liver biopsy was not a prerequisite to starting antiviral therapy.”
Overall, the study indicated that treatment with pegylated interferon and ribavirin should not be withheld from HCV-infected prisoners based on pharmacoeconomic interests. The study also recommended educational and substance abuse programs for prisoners to reduce relapses into intravenous drug use and possible reinfection. It further suggested screening for mental illness, with careful monitoring of treatment compliance and follow-up for mentally ill prisoners.
PLN has reported extensively on the epidemic levels of HCV among prisoners, and on the failure by prison officials to provide adequate treatment. [See: PLN, Aug. 2007, p.1; April 2005, p.12; Aug. 2003, p.1; Jan. 2001, p.1].
An increasing number of lawsuits have been filed over the failure to treat HCV-positive prisoners; for example, on July 8, 2008, the California law firm of Khorrami, Pollard & Abir filed a class action suit on behalf of state prisoners due to inadequate or non-existent treatment for hepatitis C.
“Despite an established standard of care, the California Department of Corrections and Rehabilitation has adopted protocols designed to exclude patients from diagnostic biopsies and treatment,” stated attorney Shawn Khorrami. “This is in contrast to the care and treatment provided to the general population. This practice not only denies inmates proper care and allows their health to deteriorate, but also presents a health danger of further spreading the disease not only within the prison population but also in the general population once the infected inmates are released from prison.” See: Jackson v. Traquina, U.S.D.C. (ED Cal.), Case No. 2:08-cv-01954-MCE-JFM.
Sources: “Treating Hepatitis C in the Prison Population is Cost-Saving,” Hepatology, November 2008 (available online at www.interscience.wiley.com); Wiley-Blackwell press release; www.corrections.com
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