Hepatitis C eradication hinges on prisons' drug costs

Successful eradication of hepatitis C must include prisons, according to Dr. Anne Spaulding, associate professor of epidemiology.

Because of the opioid epidemic, high numbers of prisoners are infected with the hepatitis C virus. While the correctional system is an ideal place to screen for and treat hepatitis C, care for infected prisoners is stuck in a vicious catch-22. New, direct-acting antivirals are effective but pricy, carrying a $70,000 list price that is expensive for prisons. Yet, these agents are cost-effective for society as a whole.

"Hepatitis C has not generated a sense of urgency," says Spaulding, "perhaps because of its slow course, low prevalence in the general population, high cost of treatment, or spread outside the public’s eye, primarily within groups that reside in the social shadows of poverty and drug use."

Correctional facilities actually face a disincentive to even screen for hepatitis C virus because positive test results legally increase their responsibility to treat infected patients. Prisons bear the up-front costs for screening and treating, but society reaps the future benefits in averted medical costs from end-stage liver disease, lives saved, and prevention of new infections in the community.

Based on the $70,000 sticker price of a full course of direct-acting antivirals, providing treatment to the 135,000 people who remain in prison in the U.S. long enough to complete it would collectively cost prison systems approximately $9.4 billion.

Spaulding explains that complex federal laws prevent pharmaceutical companies from discounting the cost of these medications for prisons, as they do for safety-net hospitals and the Veterans Affairs system. In a recently published paper in ID Clinics in North America, Spaulding proposes a scenario whereby drug manufacturers could use nominal pricing (defined as less than 10 percent of the average manufacturer price) to supply antivirals to correctional facilities at $200 to $4,000 per course. Prisons are a sizable undertapped market for manufacturers, and these substantially lower prices provide a "win-win scenario" in which more incarcerated persons can be treated in a first step toward hepatitis C eradication, and pharmaceutical companies would still make money.

Related Links

"Lowering drug costs for hepatitis C would increase treatment in prisons, researchers suggest" (5/18/18)

"Emory researchers and colleagues receive $1.2 million grant for hepatitis C elimination research" (12/21/17)