Tags: hepatitis | sovaldi | prisoners

Should Prisoners Get Pricy Hepatitis C Drug?

Tuesday, 21 October 2014 05:06 PM

When prisoners have hepatitis C, treating them with expensive new antiviral drugs makes fiscal sense despite the hefty price tag, according to a new study.
Based on computer models, new pricey drug combinations that treat hepatitis C infections were more cost-effective than older drug combinations and no treatment at all, researchers found.

“Essentially what our model does is follow a hypothetical cohort of prisoners that looks like a prison population in the U.S.,” Jeremy Goldhaber-Fiebert told Reuters Health.

“It allows us to ask a variety of ‘what-if’ questions and probe how sensitive our findings are to various factors,” said Goldhaber-Fiebert, the study’s senior author from Stanford University in California.

Hepatitis C is a viral infection of the liver that is typically transmitted when the blood of an infected person enters the body of a healthy person. (Most commonly, this happens when people share needles, syringes, or other equipment to inject drugs - but before 1992 hepatitis C was also transmitted by blood transfusions.)

When people are first infected, the symptoms can include fever, nausea, stomach and joint pain, dark urine, vomiting and a yellowing of the skin and eyes.

If left untreated, hepatitis C can slowly, over years or decades, lead to liver damage, liver
failure, liver cancer, and a need for liver transplant, according to the Centers for Disease Control and Prevention (CDC). It may also lead to death.

The CDC says about 3.2 million people in the U.S. are infected with the chronic disease. Goldhaber-Fiebert and his colleagues write in Annals of Internal Medicine that about 500,000 incarcerated people have hepatitis C.

Until recently, the virus was treated with a combination of drugs that had to be taken for about a year and caused people to have flu-like symptoms. The treatment was only effective in a minority of patients.

The U.S. Food and Drug Administration (FDA) approved Merck’s Victrelis, which is known generically as boceprevir, in 2011 to be added to the existing combination of drugs. The new combination made the treatment more effective - and more expensive.

Then, the FDA approved Gilead’s Sovaldi, which is known generically as sofosbuvir, in 2013. The drug is taken for 12 weeks and cures a majority of patients but comes with a price tag of $84,000.

Insurers have pushed back against the price of the new medication.
To examine benefits and costs associated with hepatitis C treatment among the U.S. prison population, the researchers used a computer model. They compared prisoners who received 12 weeks of Sovaldi plus the original drug combination, prisoners who received 28 weeks of Victrelis plus the original drug combination and prisoners who did not receive treatment.

They examined costs of treatment in terms of quality–adjusted life years (QALY), which is the amount of time in good health that inmates could gain from the treatment.

Overall, they found the combination of Sovaldi and the original drugs added 2.1 QALYs at a cost of about $54,000, compared to no treatment.

The combination including Sovaldi cost about $25,700 per QALY gained among prisoners serving short sentences and about $28,800 per QALY gained among those serving long sentences. The difference in cost can be partially attributed to various factors, including the increased risk of reinfection among people still in prison, Goldhaber-Fiebert said.

In either case, he and his colleagues found Sovaldi combination of drugs to be less expensive per QALY than the Victrelis combination.

However, there are other challenges when choosing a hepatitis C treatment for prisoners, the researchers write.

For example, treating U.S. prisoners infected with hepatitis C with the Sovaldi combination may come at an upfront cost exceeding $30 billion to the prison systems. The cost benefits may not be realized until the prisoners are released on another healthcare system like Medicaid, which is government-run insurance for the poor.

“Most people in will be out,” said Dr. Anne Spaulding. “We’re looking at a disease that will take 30 years to progress. A lot of hepatitis C that we’re not treating in the prison will end up being very costly not just for patients who are on Medicaid, but patients who do not have Medicaid who present to emergency rooms. Someone will have to pay.”
Spaulding, who wasn’t involved with the new study, is an expert on hepatitis C infections among U.S. prisoners. She’s an assistant professor at Emory University’s Rollins School of Public Health in Atlanta.

The U.S. Federal Bureau of Prisons currently recommends Sovaldi for many prisoners with hepatitis C infections.

“I think the key message would be to those who control state budgets,” said Spaulding.

“There are benefits to considering the health of future taxpayers, future citizens and people returning to the community. There are benefits to treating hepatitis C while they’re incarcerated.”

“The group that can have the most affect on increasing the new infections of hepatitis C is actually the injection drug users,” she said. “If you can get rid of the hepatitis C while they’re in prison, they can’t spread hepatitis C when they’re in the community.”

“It’s a message that needs to go to the decision makers who control the purse strings,” she said, adding that this is especially true for people who control state budgets.

Goldhaber-Fiebert said prisons and jails in the U.S. should give careful consideration to the hepatitis C treatment for the population that they provide services to.

“High-cost treatments can also be high-value if they deliver substantial enough value,” he said.

© 2019 Thomson/Reuters. All rights reserved.

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When prisoners have hepatitis C, treating them with expensive new antiviral drugs makes fiscal sense despite the hefty price tag, according to a new study. Based on computer models, new pricey drug combinations that treat hepatitis C infections were more cost-effective than...
hepatitis, sovaldi, prisoners
Tuesday, 21 October 2014 05:06 PM
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