Here’s a chance to lock up some savings.
The high cost of hepatitis C drugs may be straining budgets nationwide, but the country can save money if prison inmates are screened and treated for the disease, according to a new study.
Using computer models, the researchers determined that treatment could lower infection among both prisoners and society, overall. How so? If more inmates are treated, the disease would be less likely to spread within prisons, where an estimated 17 percent of the population is already infected. Beyond that, hepatitis C would be less likely to spread in the wider population once inmates are released. About 1 percent of the general US population is believed to have hepatitis C.
Depending upon the screening and treatment scenario, the study concluded that the costs associated with hepatitis C could be reduced anywhere from $260 million to as much as $760 million, according to the study, which was published in the Annals of Internal Medicine. The estimates vary depending upon whether only inmates most at risk for the disease — those with a history of injected drug use — are screened for just one year or if every inmate is screened over a 10-year period.
The varying approach could be expected to diagnose from 42,000 to 123,000 new cases among inmates over a 30-year period. And treating these people when their illness reached an advanced stage could prevent between 5,500 to 12,700 new transmissions during that time. Compared with no screening, prison screening could prevent between 4,200 and 11,700 liver-related deaths.
The researchers calculated that screening and treatment would require an added 12.4 percent increase in the health care budgets of state and federal prisons during the first year such an effort is undertaken. But that would eventually decline to an annual budget increase of less than 0.7 percent after 15 years.
“The problem is that not enough prisoners are getting treated because the drugs do cost a lot,” said Jagpreet Chhatwal, a study co-author and health economist at Massachusetts General Hospital’s Institute for Technology Assessment. “Meanwhile, this is a population where many have used drugs, shared needles, and infected others. If prison budgets can afford [the drugs], there could be long-term substantial savings.”
Chhatwal coauthored a separate study earlier this year that, similarly, found the hepatitis C drugs are cost-effective, but the price may keep them out of reach of some patients.
The medicines, Sovaldi and Harvoni, cost between $63,000 and $94,500, depending upon the drug and regimen, before any discounts, such as those received by the Federal Bureau of Prisons. Despite the hefty price tags, Gilead Sciences, the makers of the drugs, has argued that they have 90-plus percent cure rates that would, in the long run, cost less than treating liver cancer or transplants.
Just the same, the prices have prompted many public and private payers to restrict access to treatment. And the issue appears to have affected prisons, as well. For instance, a proposed class action lawsuit was filed earlier this year by two inmates in Massachusetts state prisons for failing to provide hepatitis C treatment to most infected prisoners.
“You can’t look at this issue and not understand that cost is at the heart of everything here,” said Joel Thompson, a staff attorney with Prisoners’ Legal Services of Massachusetts, a nonprofit that represents the inmates. “There is an opportunity here to eradicate the disease.” We asked the Massachusetts Department of Corrections for comment and will pass along any reply.
Unlike in some other countries, the United States does not have an official measurement for determining cost effectiveness. So the researchers used a threshold of $100,000 as a benchmark for assessing QALY, or quality-of-life years, which measures both the quantity and quality of life generated by providing a treatment or some other health care intervention.
Chhatwal said the simulation found that the scenario in which every inmate is screened over a 10-year period would cost up to $29,000 for each quality-adjusted life year. He called this a “good value.”