The treatment of inmates remains a hot-button issue that includes a wide range of different considerations, ranging from how well cared-for a prisoner should be to the economics involved in maintaining the prison population. New research from Stanford, however, suggests that new HCV therapies, though expensive, may in the end offer long-term cost-saving benefits for those who are incarcerated.
One of the most pressing health concerns among incarcerated Americans is Hepatitis C, which affects an average of 1 in 6 inmates as opposed to the general population’s HCV prevalence of 1 in 100. As rates of imprisonment increase, so do HCV infections in prisons across the country, equating to an estimated 400,000 infected inmates out of 2.3 million. The virus is contracted through direct contact with bodily fluids, as in sexual acts, and in intravenous drug use.
Breakthrough HCV treatments such as sofosbuvir can cost as much as $7,000 a week for a 3-month treatment. If all infected inmates were granted treatment, it would cost the nation billions of health dollars. Out of this pressing issue, a group of researchers from Stanford University discovered Sovaldi (sofosbuvir) is by far the most cost-efficient, FDA-approved treatment. Senior author and assistant professor of medicine at Stanford, Jeremy Goldhaber-Fiebert, PhD, explains this particular medication’s additional benefits should outweigh its hefty price tag. His team’s study is now published in the Annals of Internal Medicine, with Shan Liu, PhD, as lead author.
The standard until recently were 48-week treatments that consisted of potent drug combinations that would cause the patient to experience a number of side effects such as fatigue, nausea and headache. In the end, the drug would only be effective on less than half of those receiving it. 3 years ago, Victrelis (boceprevir) received FDA-approval. This was used with the standard interferon + ribavirin, but while it proved to be more effective, it was also just as expensive. Sovaldi entered the market fairly recently, in December 2013, and is known to be an even more effective option, but is still too expensive.
Goldhaber-Fiebert and his team designed a computer model to plot these two drugs’ therapeutic performance in relation to cost, with a high risk population and environment in mind, such as a prison setting. One scenario provided inmates with 12 weeks worth of sofosbuvir with interferon and ribavirin, while another received 28 weeks worth of boceprivir with the same combination. Other factors such as length of sentence and current liver health status were considered.
Effectiveness was measured using quality-adjusted life years (QALYs), which scores each intervention according to how many years of optimal health it can add to a patient’s life. Their findings revealed sofosbuvir scored 2.1 QALYs with a cost of $54,000, while boceprivir scored only 1.3. While sofosbuvir would entail a higher up-front cost, treatment with boceprivir would actually end up costing more because of less long-term efficacy, and risk for complications.