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Tuesday, December 6, 2016

By Michael Ollove, Stateline.org

WASHINGTON — The U.S. is in the midst of a hepatitis C epidemic with as many as 3.9 million Americans infected with the liver-damaging virus. Aggressively targeting a concentrated population with the contagious but curable disease could be the best approach to eradicating the deadly virus.

The most logical place to launch the counterattack is in the country’s jails and prisons, where the infection rate is about 17 percent, compared with 1 percent to 2 percent overall in the U.S., said Josiah Rich, a Brown University infectious disease physician. A recent study estimated that 1.86 million people with the virus were incarcerated.

“With more than 10 million Americans cycling in and out of prisons and jails each year, including nearly one of every three HCV (hepatitis C)-infected people,” Rich said, “the criminal justice system may be the best place to efficiently identify and cure the greatest number of HCV-infected people.”

Rich, the lead author of an opinion piece published last week in the New England Journal of Medicine, said treating prison populations could have a “substantial effect on this epidemic.”

Hepatitis C is a blood-borne virus most typically spread through intravenous drug use, transfusions and tattooing. Although it can remain asymptomatic for decades, the virus can eventually cause catastrophic liver damage, including cirrhosis, cancer, liver failure and death.

In addition to teaching at the medical school at Brown, Rich is director and co-founder of the Center for Prisoner Health and Human Rights at the Miriam Hospital Immunology Center in Providence, Rhode Island. He has raised the possibility of eradicating the disease following the government approval last year of two new medications that boost the cure rates for hepatitis C from about 45 percent for the older drugs to better than 90 percent.

But there’s a big hitch: the price tag. At $1,000 a pill for the new medicine, a single course of treatment for an individual costs as much as $84,000. Because of the high cost of the new drugs, all payers, public and private, are grappling with questions about which patients should get the new medications and how to pay for them.

The new drugs, simeprevir (marketed as Olysio by Janssen Therapeutics, a division of Johnson & Johnson) and sofosbuvir (sold as Sovaldi by Gilead Sciences) offer other advantages aside from their cure rates. They can be taken orally rather than through injection. The course of treatment is much shorter than previous drugs — 12 to 24 weeks compared with 48. And they produce none of the serious side effects caused by the previous medications, including nausea, fever, headaches and insomnia.

To Rich, the advent of these drugs presents an opportunity that he insists must include correctional facilities as an essential component.

“We can invest now in treating this epidemic and curing large numbers of people and preventing a lot of illness, death, and expense,” Rich told Stateline. “If we made a national push to avoid that death and illness and expense, we’d want to roll out as much treatment as possible in the place where we’d find the highest number of people with the virus. And that’s in the jails and prisons.”

But as Rich notes in his article, treating all the infected people currently incarcerated would cost $33 billion. He said that treating just half of the people with hepatitis C who cycle in and out of jail or prison in a year’s time would cost $76 billion. To put those numbers in perspective, total government spending for all states combined in fiscal 2013 was just under $700 billion.

Correctional systems, funded by states or localities, hardly have those kinds of resources, which is why Rich believes federal intervention will be necessary. He suggested as a precedent the Ryan White CARE Act, originally authorized in 1990, which provided federal resources to combat HIV/AIDS.

But more than three times as many Americans are believed to be infected with hepatitis C than HIV. Rich’s article does not address how to overcome the cost, but in an interview, he suggested the federal government should negotiate a rate with the pharmaceutical companies on behalf of states and their corrections systems.

“The government could come back and say, ‘You should make a profit, absolutely. But you can make a profit by selling a few doses of the medication or you could make a profit by selling a whole lot of doses.'”

Photo: Me via Flickr
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