Beckman Adam L, Bilinski Alyssa, Boyko Ryan, Camp George M, Wall A T, Lim Joseph K, Wang Emily A, Bruce R Douglas, Gonsalves Gregg S
Adam L. Beckman was an undergraduate at Yale College and research assistant at the Yale Global Health Justice Partnership, both in New Haven, Connecticut, when completing this work.
Alyssa Bilinski is a PhD candidate in health policy in the Harvard Graduate School of Arts and Sciences, in Cambridge, Massachusetts.
Health Aff (Millwood). 2016 Oct 1;35(10):1893-1901. doi: 10.1377/hlthaff.2016.0296.
Prisoners bear much of the burden of the hepatitis C epidemic in the United States. Yet little is known about the scope and cost of treating hepatitis C in state prisons-particularly since the release of direct-acting antiviral medications. In the forty-one states whose departments of corrections reported data, 106,266 inmates (10 percent of their prisoners) were known to have hepatitis C on or about January 1, 2015. Only 949 (0.89 percent) of those inmates were being treated. Prices for a twelve-week course of direct-acting antivirals such as sofosbuvir and the combination drug ledipasvir/sofosbuvir varied widely as of September 30, 2015 ($43,418-$84,000 and $44,421-$94,500, respectively). Numerous corrections departments received smaller discounts than other government agencies did. To reduce the hepatitis C epidemic, state governments should increase funding for treating infected inmates. State departments of corrections should consider collaborating with other government agencies to negotiate discounts with pharmaceutical companies and with qualified health care facilities to provide medications through the federal 340B Drug Discount Program. Helping inmates transition to providers in the community upon release can enhance the gains achieved by treating hepatitis C in prison.
在美国，监狱承担了丙型肝炎疫情的大部分负担。然而，对于州立监狱中丙型肝炎治疗的规模和成本，人们知之甚少——尤其是自直接作用抗病毒药物问世以来。在41个上报数据的惩教部门所在的州，截至2015年1月1日前后，已知有106,266名囚犯（占囚犯总数的10%）患有丙型肝炎。这些囚犯中只有949人（0.89%）正在接受治疗。截至2015年9月30日，索非布韦等直接作用抗病毒药物为期12周疗程的价格以及复方药物雷迪帕韦/索非布韦的价格差异很大（分别为43,418美元至84,000美元和44,421美元至94,500美元）。许多惩教部门获得的折扣比其他政府机构要小。为减少丙型肝炎疫情，州政府应增加对感染囚犯治疗的资金投入。州惩教部门应考虑与其他政府机构合作，与制药公司协商折扣，并与合格的医疗保健机构合作，通过联邦340B药品折扣计划提供药物。帮助囚犯在获释后转至社区的医疗服务提供者处，可以提高在监狱中治疗丙型肝炎所取得的成效。
