Around the country, prisoners are clamoring to be cured of a potentially deadly disease, while prison administrators are reeling from the treatment’s price tag. Hepatitis C, a virus that can eventually cause cirrhosis, liver cancer, and other serious outcomes, affects some three million Americans, one-third of whom pass through U.S. prisons and jails each year.
One 12-week treatment course can cost upwards of $90,000. With a constitutional obligation to provide medical care to inmates, prison officials—whose health-care budgets are a zero-sum proposition—are struggling to treat even a fraction of those with the disease.
But a new study suggests that despite its cost, 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.
“Hepatitis C is a progressive disease—it could take 30 years to progress to advanced liver cancer,” says Dr. Jagpreet Chhatwal, a radiologist at Harvard Medical School and the study’s senior author. “If you compare that to the average time spent inside prison, which is three to five years, it would make sense these people would be part of the community when this started happening.”
Transmitted primarily by injection drug use, hepatitis C afflicts 17% of prisoners, compared to 1% of the general population. Public health advocates have for years described testing and treatment of hepatitis C in prison as a “public health opportunity.” Given high rates of the disease, “testing, education, and, when appropriate, treatment of prisoners should be a cornerstone of the public health response to the hepatitis C epidemic in the United States,” argued three correctional and public health physicians in a medical journal 10 years ago (and again last year).