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Research documents high rates of hepatitis C in prisons

Inmate treatment, diagnosis costs exceed R.I. Department of Corrections’ budget

Hepatitis C affects millions of people nationwide, but the disease is especially prevalent in prisons: Approximately 17 percent of Rhode Island inmates are infected, according to a new study by University researchers.

Diagnosing and treating all of these cases incurs a large financial burden on the R.I. Department of Corrections — a cost that is probably not realistically affordable under the current budget, the researchers report in a paper on the topic, which was published in the April issue of the Journal of Urban Health.

The Department of Corrections currently focuses its resources on infected inmates whose diseases have progressed to a late stage, said Brian Montague, assistant professor of medicine and health services, policy and practice, who led the study. The department would ideally test and treat all prisoners at risk for becoming infected with hepatitis C, but “that amount of money would be an order of magnitude beyond what they could support,” Montague said.

Full treatment of the virus can involve several rounds of medication. “If they put all that work in, the bill just goes up and up and up,” Montague said.

Treating all inmates with greater than six months remaining in their prison sentences would cost around $34 million, which is 13 times the department’s pharmacy budget, according to the study.

For years, issues regarding hepatitis C centered around treatment methods, said Andrew Talal, professor of medicine at the University at Buffalo, who was not involved with the study. As of October, the U.S. Food and Drug Administration approved a new oral combo therapy, which has a much higher efficacy than any prior treatment methods, he added.

Now, the biggest problem regarding hepatitis C treatment is the cost, Talal said, adding that the cost to treat one patient is about $150,000. “The burden is not ‘How do we get patients cured?’ but ‘How do we treat the largest number of patients?’”

Hepatitis C among the prison population is typically associated with injection drug or cocaine use, Montague said. Many people who engage in these behaviors end up in prison, raising the disease’s prevalence within correctional institutions, he said.

One of the biggest problems facing correctional facilities’ medical care is that prisoners are not eligible for Medicare or Medicaid, Montague said. These programs typically cover the vast majority of patients’ required treatments for hepatitis C, but instead the full cost of care falls to the department, which is unreasonable for the size of its budget, he added.

“As a patient, it doesn’t sound good to hear ‘Well, you don’t have late-stage liver disease so we’re not going to treat you,’” Montague said.

But there are a variety of issues with only treating patients with end-stage liver disease, Talal said. Untreated patients leave a “resevoir of infection,” which can harm other people in addition to the patients themselves.

But the department’s triage strategy — focusing on patients with the most dire need — is one of the most reasonable ways to solve the budget problem, Montague said.

To reconcile the immense financial and public health issue, the Department of Corrections should seek new payment strategies, such as working with outside programs, the authors wrote in the study. New treatments are currently being developed that are more costly and more effective. The earlier the problem is fixed, the better, the authors concluded.


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