Costs To Treat Inmates With Hepatitis C Potentially Staggering

Brian Montague, DO MS MPH Assistant Professor of Medicine and of Health Services, Policy and Practice Division of Infectious Diseases Brown University / The Miriam HospitalMedicalResearch.com Interview with:
Brian Montague, DO MS MPH
Assistant Professor of Medicine and of Health Services, Policy and Practice
Division of Infectious Diseases
Brown University / The Miriam Hospital

Medical Research: What is the background for this study?

Dr. Montague: Hepatitis C is in an important public health problem affecting 4-5 million persons in the US alone.  Given the risk of infection associated with drug use, the prevalence of hepatitis C in corrections has been significantly higher than in the general population.

Prior to 2013, the available treatment options were both expensive and of significant toxicity and limited efficacy.  Uptake to these therapies were low.  Starting in 2013, new therapeutics options offering shorter course treatments and efficacies greater than 90% became available.  These therapies offer new possibilities to increase uptake to treatment, however the cost of the therapies has made rapid scale up of treatment impossible.  Given the risk of serious harms to patients with advanced liver disease if not treated, insurance has begun to approve these new therapies for patients with more advanced disease.

Departments of corrections are obliged to provide the same standard of care to persons in corrections as they would receive in the community.  Unlike Medicaid and community insurance providers, correctional systems worker under a fixed budget. Large increases in expenditures for treatment of hepatitis C without establishing mechanisms to offset these costs risks compromising other essential programs and functions in the correctional health system.

Medical Research: What are the main findings?

Dr. Montague: In a cross-sectional analysis we estimated the burden of hepatitis C within the department of corrections.  At the time of the study, an estimated 836 persons have chronic hepatitis C.  Among these an estimated 119 have advanced liver disease, stage 3 or 4 fibrosis, and would meet criteria for treatment under most insurance programs.  Even a conservative approach of restricting treatment in corrections to those with stage 3 or 4 fibrosis would incur costs of over $15 million, which is greater than 6 times the current correctional health budget for pharmaceuticals and 76% of the overall correctional health budget.

Medical Research: What should clinicians and patients take away from your report?

Dr. Montague: The cost effectiveness of treatment of hepatitis C has been well established when considering the long term cost savings associated with averting development of cirrhosis, liver cancer and other complications of end stage liver disease.  Achieving those benefits, however, will require a substantial reconsideration of how the immediate costs of treatment can be supported in the context of existing systems.  This may require rethinking in some aspects the mandate that all the costs of health care in correctional settings be supported by the current correctional health budgets.

Medical Research: What recommendations do you have for future research as a result of this study?

Dr. Montague: Increased attention needs to be given to strategies to improve screening and evauation of hepatitis C in corrrections, with the goal of identifying those individuals with advanced fibrosis and assuring that they receive the needed therapies.  For those with less advanced fibrosis for whom release may be expected, strategies to support testing with linkage to care in the community are needed to assure that those individuals not able to be treated in corrections are retained care and linked to needed follow-up in the community on release.

Citation:

John T. Nguyen, Josiah D. Rich, Bradley W. Brockmann, Fred Vohr, Anne Spaulding, Brian T. Montague. A Budget Impact Analysis of Newly Available Hepatitis C Therapeutics and the Financial Burden on a State Correctional System. Journal of Urban Health, 2015; DOI: 10.1007/s11524-015-9953-4

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MedicalResearch.com Interview with: Brian Montague, DO MS MPH (2015). Costs To Treat Inmates With Hepatitis C Potentially Staggering