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Study Shows Treating Prisoners with Hepatitis C is Cost Effective

Chronic hepatitis C is common in U.S. prisons, with prevalence estimates ranging from about 10% to about 30%. A significant proportion of the HCV-infected population passes through the correctional system each year, providing a prime opportunity for diagnosis and treatment.

A study by Jennifer Tan and colleagues published in the November 2008 issue of Hepatology looked at the cost-effectiveness of treating prisoners with chronic hepatitis C using pegylated interferon plus ribavirin. Such treatment has been shown to be cost-effective in the general population, and studies have also demonstrated that treated prisoners can achieve good sustained virological response (SVR) rates.

In this analysis, cost-effectiveness was determined using a decision analysis model employing Markov simulation. The model assumed that the cohort of prisoners to be treated had a distribution of HCV genotypes and fibrosis stages similar to those observed in prior studies of inmate populations. The probability of transitioning from one health state to another, reinfection rates, in-prison and out-of-prison mortality rates, SVR rates, cost, and quality of life were also obtained from the existing medical literature.

Results

• In a strategy without pre-treatment liver biopsy, treatment was cost-effective for all ages and HCV genotypes.
• This model was robust with varying rates of disease progression, mortality, reinfection, SVR, and cost.
• In a strategy employing pre-treatment biopsy, treatment was cost-saving for prisoners of all ages and genotypes who had portal fibrosis, bridging fibrosis, or compensated cirrhosis.
• However, treatment was not cost-effective for prisoners aged 40-49 who had no fibrosis and HCV genotype 1.

"Treatment of chronic hepatitis C with pegylated interferon and ribavirin in U.S. prisons results in both improved quality of life and savings in cost for almost all segments of the inmate population," the investigators concluded. "If the decision to treat hepatitis C is based on pharmaco-economic measures, this significant proportion of infected individuals should not be denied access to therapy."

These results are consistent with current guidelines that recommend treatment for chronic hepatitis C patients with evidence of liver disease progression. Many experts recommend treating all patients with easy-to-treat HCV genotypes 2 or 3, since treatment is short (24 weeks) and the sustained response rate is high, but are more cautious with genotype 1, which requires longer therapy (48 weeks) and fails to produce a sustained response about half the time.

Department of Medicine and Department of Surgery, University of California at Los Angeles, Los Angeles, CA.

1/13/09

Reference

JA Tan, TA Joseph TA, and S Saab. Treating hepatitis C in the prison population is cost-saving. Hepatology 48(5): 1387-1395. November 2008.