That’s not how things panned out. Because the most serious complications of hepatitis C can take decades to emerge, cash-strapped correctional officials have been reluctant to treat seemingly healthy inmates whose medical problems won’t show themselves until long after they are released. What’s more, first-generation treatments took up to a year, caused serious side-effects, and were only effective about half the time for most patients. Even prisons with dedicated treatment programs were treating a few dozen people out of the hundreds of thousands of prisoners with hepatitis C.
Now, new hepatitis C medications can cure 90% of patients in as few as 12 weeks; guidelinesfrom the major medical societies recommend treating all patients with hepatitis C—and single out incarcerated people as a group for whom treatment could have the secondary benefit of preventing transmission to others. But still prison administrators in most states have been slow to offer testing or treatment in any substantial numbers. (In Massachusetts and Minnesota, prisoners have filed class-action lawsuits to gain access to the drugs.)
“There is an incentive for prisons to put their head in the sand,” says Emory Medical School’s Anne Spaulding, one of the co-authors of the paper. “The more cases you find with aggressive screening, the more cases you might need to treat.”
This new paper, which appears in the medical journal Annals of Internal Medicine, found that universal screening—and treatment of any prisoner whose liver disease is found to be moderate or severe—could avert $760 million in spending on liver transplants and other medical care over thirty years. At least 80% of that spending would have been in the general population. “That’s the whole motivation of this paper, showing if we start treating people in prison, the whole society benefits,” says Chhatwal. Because the benefits would accrue to society at large, and not to the prison, Chhatwal suggests that state and federal governments should step up and provide supplemental funding to manage hepatitis C in prisons. The paper put the first-year cost of implementing the screening and treatment programs at $1.1 billion across the state and federal systems—about 12 percent above what they’re spending on health care now. “Cost effective” is not the same as cost saving: “It means something will cost additional money, but it’s worth spending,” Chhatwal said.
By Beth Schwartzapfel, The Marshall Project
This copyrighted story comes from The Marshall Project, a nonprofit news organization that covers the U.S. criminal justice system. All rights reserved.
This article was reprinted from The Black AIDS Institute.