HCV:
The Correctional Conundrum
(continued)
Cost of HCV Treatment
With the high prevalence
of HCV infection among incarcerated individuals, there is a concern that
treatment could overwhelm some systems' healthcare budgets. Medical decision
analyst J. Wong calculated that six months of combination therapy resulted
in net savings in the range of $400 to $3500 over the lifetime of each
HCV infected patient.36 Dr. Wong's analysis ranked combination therapy
for HCV in the same range of cost effectiveness as stool guiac testing,
pneumococcal vaccination, coronary bypass surgery, and mammography. It
must be noted however that the cost savings that may accrue from treatment
of prisoners are primarily to society as a whole. While treatment of incarcerated
individuals for hepatitis and HIV is the right thing to do and can tremendously
benefit the public health, it is not realistic to expect correctional systems
to shoulder this financial burden without assistance.
Management
Since the incidence of side
effects to HCV combination therapy can be relatively high, and it can be
difficult for incarcerated patients to quickly access their clinician to
report side effects, it is important to:
ñspend time preparing the
patient for the potential treatment-related side effects,
ñconsider following the
patients in a dedicated hepatitis clinic,
ñuse a nurse or other staff
person to regularly check in with patients who are receiving HCV treatment
so that side effects can be rapidly addressed.
One suggestion for reducing
the cost of managing chronically HCV infected individuals in corrections
is to make use of existing "chronic disease" clinic infrastructure and
expertise existing on site - since HIV and HCV are fellow travelers, and
correctional medical units might insist that the ID (HIV) expert acquire
expertise in HCV and HBV management. Some clinics have set up flow sheets
to reduce repetitive, unnecessary testing.
Without a good support system,
a high percentage of patients will fail to complete therapy. Because
of the high cost of treatment, time spent preparing patients and supporting
them while on treatment is likely to be cost effective.
CONTINUE...
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