Today’s Managing Health Care Costs Number is 11,730
The headline in Kaiser Health News is “Testing For Hepatitis C In Prisons Could Save Many Lives On The Outside.”
…testing all prison inmates for hepatitis C—and treating them when appropriate—is extremely cost-effective. Using an “opt-out” system—testing each prisoner as a matter of course unless he specifically declines—could prevent between 10,900 and 12,700 new hepatitis C infections, most of which would occur in the community after infected prisoners returned home. The study also found the testing and treatment would lead to a significant decrease in the number of liver transplants, cases of liver cancer, and other liver-related deaths in the community.
The KHN reporter adds in the concluding paragraph:
“Cost effective” is not the same as cost saving: “It means something will cost additional money, but it’s worth spending…”
Exactly.
The study was in the November 24 issue of Annals of Internal Medicine, and projects that such screening would cost about $1.15 billion in the first year – and progressively less over time. Nine out of ten prevented cases of Hepatitis C would be outside of prison, as most prisoners eventually leave prison and provide a reservoir for infection of the general population. The simulation is robust – and incorporated likely pharmacy discounts and used a 3% discount rate. It projected that 10 years of screening would prevent 11,730 deaths.
The authors included a chart (below) showing infections and costs prevented – but relegated the costs incurred to a table. I’ve put them in the graphic above. You can see that the expense of treatment is much more than the cost savings.
We absolutely should pay for screening and treatment of Hepatitis C in prisons. Incarceration should not lead to a lifetime of disability and sickness nor be a death sentence. We have the chance to make Hepatitis C a rare disease – and we will fail to do this if we don’t test and treat prisoners. Thousands will unnecessarily die, and many more will have quality adjusted life years ripped away from them. Most of the victims will not be prisoners.
Prisons worried about the cost of hepatitis treatment even before the new expensive (tolerable and effective) medications became available. The current system of relying on states to fund this care is simply not going to work. We need a national fund for Hepatitis C treatment – much as we “nationalized” end stage renal disease care by making those on dialysis eligible for Medicare.
We have the potential to eradicate a deadly virus, one that kills more Americans each year than HIV. The cost per quality adjusted life year is less than $30,000. It’s cruel and sad that we seem unlikely to take the necessary action.
Graphic of prevented infections and costs from the Annals of Internal Medicine article.
