Hepatitis C is a chronic viral infection that leads to liver damage. It is spread through contact with blood from an infected individual and affects over 500,000 inmates in the United States.
Treatment options are available for Hepatitis C, but just one round is expensive. Think $7,000-a-week kind of expensive, and one treatment involving a drug called sofosbuvir would require 12 weeks. Believe it or not, though, sofosbuvir (brand name Sovaldi) is actually the most cost-effective treatment available.
This is according to a study published in the Annals of Internal Medicine. Led by Shan Liu, Ph.D., researchers from Stanford University compared sofosbuvir with other treatment options for hepatitis C that have passed U.S. Food and Drug Administration standards. Sovaldi was approved in 2013.
According to the study's senior author, Jeremy Goldhaber-Fiebert, Ph.D., the additional benefits of the drug are numerous enough given the high-risk population it is addressing, which justifies sofosbuvir's high cost.
A few years ago, treatment for hepatitis C involved a two-drug regimen that lasted for 48 weeks. However, the drugs used, ribavirin and pegylated interferon, caused side effects such as headache, nausea and fatigue. Not to mention that the treatment managed to only eliminate hepatitis C infections in less than half of those using it.
Boceprevir was approved in 2011 and it dramatically improved results when used alongside ribavirin and pegylated interferon. But this kind of hepatitis C treatment was also more expensive.
Goldhaber-Fiebert and colleagues created a digital model that compared the cost and performance of boceprevir used with ribavirin and pegylated interferon and sofosbuvir with ribavirin and pegylated interferon.
Within a hypothetical population in a prison, two scenarios were carried out: one involved treating infected inmates with the boceprevir-ribavirin-interferon combo of drugs while the other had individuals with hepatitis C being treated with sofosbuvir, ribavirin, and interferon. The boceprevir group was under treatment for 28 weeks while the sofosbuvir group was treated for 12 weeks.
QALYs or quality-adjusted life years were used for measuring outcomes. The boceprevir treatment yielded on an additional of 1.3 QALYs. The sofosbuvir treatment, on the other hand, which was $54,000 more expensive, offered 2.1 additional QALYs.
"Overall, sofosbuvir is cost-effective in this population, though its budgetary impact and affordability present appreciable challenges. Though often not the focus of health-policy research, HCV-infected inmates are a population that may benefit particularly from a highly effective, short-duration treatment," said Goldhaber-Fiebert.
The study didn't take into account where money for the recommended hepatitis C treatment would come from. However, while upfront costs will be high, sofosbuvir treatment will save the prison system's health care program more in the long run as payouts for treating complications that may arise from hepatitis C will be more expensive.