Treating Patients in Prison with New Hepatitis C Drugs Could Break Budgets

High cost of new drugs make treating even the sickest inmates impractical.

The significant cost of highly effective new hepatitis C virus (HCV) drugs renders the treatment of prison inmates with these therapies unlikely, a recent study found.

The study, which examined inmates in the state of Rhode Island, found prisons would have to spend nearly double their entire health budget to treat all of the inmates infected with hepatitis C. Treating only the sickest inmates who are in custody for at least another year would exceed the prison pharmacy budget more than 5 times over, the study noted.

"The big problem is, even if you just take the most advanced disease, you can't afford it with the current correctional budget," study lead Brian Montague, MD, said in a press release. "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."

Through the analysis of prison health records, researchers estimated 17% of the 3227 inmates incarcerated in February 2014 were chronically infected with HCV, which is consistent with prevalence estimates in other state prison systems, according to the study.

The researchers estimated 82 Rhode Island inmates have HCV genotype 1 with stage 3 or 4 fibrosis of the liver. The standard of care for this condition is the combination of sofosbuvir and ledipasvir for 12 to 24 weeks, which costs between $94,500 and $189,000.

The cost of the treatment is still much less expensive than a liver transplant or managing the complications of end-stage liver disease, the study noted.

"The cost-effectiveness of these treatments has been well-established based on preventing the development of cirrhosis and its complications," Dr. Montague said. "For patients who have stage 3 or 4 fibrosis, we know you save money by curing them."

Despite this fact, the drugs still are not feasible for prisons. The Rhode Island prison system health budget is $19.9 million overall for health, with $2.7 million for pharmaceuticals.

The total cost of treating all the HCV-infected inmates with at least 6 months of time left to serve is approximately $34.2 million, while the cost of treating only the sickest inmates is approximately $15 million and treating the sickest inmates with at least one year left to serve is approximately $12 million.

In the least expensive scenario, which is treating only the sickest inmates at a 50% drug cost discount, would still would cost $8 million. This cost is more than 40% of the total health budget for the state prison system.

"The rising cost of therapy goes beyond merely a 'sticker shock' phenomenon and needs to be seriously reevaluated," the author concluded in the journal. "Corrections have inherited an important public health opportunity to address the HCV epidemic. It is unrealistic, however, to expect correctional facilities to attempt widespread HCV treatment with the currently available budgets."