• Hepatitis C cure could devastate corrections budgets

    by  • April 9, 2014 • News

    According to a Pew report, if used widely, a new generation of antiviral drugs has the potential to wipe out the deadly hepatitis C virus in the United States. But the high price of the drugs could destroy corrections budgets across the country, where roughly one-third the population is afflicted.

    Ronald Shansky, former medical director for the Illinois Department of Corrections and founder of the Society of Correctional Physicians described the cost of the drugs to Pew as, “extortionarily high” and even criminal. Hepatitis.C.treatment

    The drugs cost anywhere from about $65,000 to $170,000 for a single course of treatment—between three and nine times more than earlier treatments.

    The two manufacturers, Janssen Therapeutics and Gilead Sciences, defend their prices, saying their medications represent a huge advance in treatment.

    A new study estimates that 1.86 million people with antibodies to the virus were incarcerated during the study year.

    The virus is passed most frequently through needle-sharing during intravenous drug use and tattooing, which are common in prisons. The study estimated the prevalence rate of hepatitis C in state correctional facilities to be about 17 percent, compared to a rate of 1 percent to 2 percent in the general population.

    The new drugs, simeprevir (marketed as Olysio by Janssen Therapeutics, a division of Johnson & Johnson) and sofosbuvir (sold as Sovaldi by Gilead Sciences), have a cure rate of  95 percent or better in some clinical studies, compared to 45 percent for previous medications.

    Unlike the alternatives, simeprevir and sofosbuvir cause only mild side effects, and can be taken orally. Furthermore, patients only have to take them for12 to 24 weeks, compared to at least 48 weeks for the previous treatments.

    The Illinois Department of Corrections has not yet provided us with the figures we’ve requested of the number of Illinois inmates infected with hepatitis C who would be eligible for treatment, but if 17 percent of the state’s roughly 49,000 inmates are infected, the cost to the correctional budget could well exceed $1 billion.

    Hepatitis C progresses slowly, but without treatment it can lead to liver failure and death. Given the grave consequences, the availability of the new drugs creates a dilemma for correctional systems. With more expensive specialty drugs expected to enter the marketplace in the coming years, the decisions will only get more vexing.

    Whether states have the option to not treat prisoners with the new drugs is open to debate. Under the Eighth Amendment, prisons are barred from demonstrating “deliberate indifference” to the well-being of prisoners.

    The courts generally have dismissed prisons’ pleas of poverty as an excuse for not providing care. At the same time, however, they tend to defer to prisons on the question of what constitutes “medical necessity.”

    Others, however, insist that with an effective cure available, it will be immoral not to treat prisoners with the new hepatitis C drugs.

    That will be especially true if early research results bear out that those with hepatitis C are more likely to develop other deadly diseases, such as diabetes and lymphoma.  In that case, the view of what constitutes medical necessity for patients in the early stages of hepatitis C could change dramatically.