A new study finds that effective new hepatitis C drugs are so expensive the state of Rhode Island would have to spend almost twice its entire prison health budget to treat all its chronically infected inmates. Even providing the medicine only to the very sickest inmates who will remain in custody for at least another year would exceed the state prison system's pharmacy budget more than five times over.
The budget impact analysis, published online in the Journal of Urban Health, provides detailed new evidence of the "sticker shock" that states face in battling an epidemic that affects millions of people nationwide. The prevalence of the liver disease, which is often spread via injection drug use, is especially high in prisons. Meanwhile, the U.S. Supreme Court has obliged prison systems to provide inmates with care comparable to what is available in the community.
"The big problem is, even if you just take the most advanced disease, you can't afford it with the current correctional budget," said Dr. Brian Montague, assistant professor medicine and public health at Brown University and a physician in the Division of Infectious Diseases at The Miriam Hospital, who led the study. "There was an option to defer treatment before because the [prior] treatments were significantly more toxic and the risks often outweighed the benefits. Now, with safe and highly effective treatments, morally and ethically there's no option to not treat, particularly for those with more advanced disease."
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