Nguyen John T, Rich Josiah D, Brockmann Bradley W, Vohr Fred, Spaulding Anne, Montague Brian T
Brown University School of Public Health, Providence, RI, USA.
J Urban Health. 2015 Aug;92(4):635-49. doi: 10.1007/s11524-015-9953-4.
Hepatitis C virus (HCV) infection continues to disproportionately affect incarcerated populations. New HCV drugs present opportunities and challenges to address HCV in corrections. The goal of this study was to evaluate the impact of the treatment costs for HCV infection in a state correctional population through a budget impact analysis comparing differing treatment strategies. Electronic and paper medical records were reviewed to estimate the prevalence of hepatitis C within the Rhode Island Department of Corrections. Three treatment strategies were evaluated as follows: (1) treating all chronically infected persons, (2) treating only patients with demonstrated fibrosis, and (3) treating only patients with advanced fibrosis. Budget impact was computed as the percentage of pharmacy and overall healthcare expenditures accrued by total drug costs assuming entirely interferon-free therapy. Sensitivity analyses assessed potential variance in costs related to variability in HCV prevalence, genotype, estimated variation in market pricing, length of stay for the sentenced population, and uptake of newly available regimens. Chronic HCV prevalence was estimated at 17% of the total population. Treating all sentenced inmates with at least 6 months remaining of their sentence would cost about $34 million-13 times the pharmacy budget and almost twice the overall healthcare budget. Treating inmates with advanced fibrosis would cost about $15 million. A hypothetical 50% reduction in total drug costs for future therapies could cost $17 million to treat all eligible inmates. With immense costs projected with new treatment, it is unlikely that correctional facilities will have the capacity to treat all those afflicted with HCV. Alternative payment strategies in collaboration with outside programs may be necessary to curb this epidemic. In order to improve care and treatment delivery, drug costs also need to be seriously reevaluated to be more accessible and equitable now that HCV is more curable.
丙型肝炎病毒（HCV）感染对被监禁人群的影响仍然极为严重。新型HCV药物为在惩教机构中应对HCV带来了机遇和挑战。本研究的目的是通过预算影响分析比较不同的治疗策略，评估在一个州惩教人群中HCV感染治疗成本的影响。查阅了电子和纸质病历，以估计罗德岛惩教部内丙型肝炎的患病率。评估了三种治疗策略如下：（1）治疗所有慢性感染者；（2）仅治疗有纤维化证据的患者；（3）仅治疗有晚期纤维化的患者。预算影响计算为假设完全采用无干扰素疗法时，药品总成本占药房和总体医疗保健支出的百分比。敏感性分析评估了与HCV患病率、基因型、市场定价估计变化、被判刑人群的住院时间以及新可用治疗方案的采用率相关的成本潜在差异。慢性HCV患病率估计占总人口的17%。治疗所有剩余刑期至少6个月的被判刑囚犯将花费约3400万美元，是药房预算的13倍，几乎是总体医疗保健预算的两倍。治疗有晚期纤维化的囚犯将花费约1500万美元。假设未来治疗的药品总成本降低50%，治疗所有符合条件的囚犯将花费1700万美元。鉴于新治疗方案预计成本巨大，惩教机构不太可能有能力治疗所有感染HCV的人。与外部项目合作的替代支付策略可能是遏制这一疫情所必需的。为了改善护理和治疗服务，鉴于HCV现在更可治愈，药品成本也需要认真重新评估，以使其更易获得且更公平。
