The hepatitis C virus causes cirrhosis, is the leading cause of certain liver cancers, and is the most frequent reason people need liver transplants.
Dealing with those costly, debilitating, and long-term illnesses takes a toll on the healthcare system.
Yet there's a solution that could greatly reduce hepatitis C (HCV) incidence and eventually overall healthcare costs: Treat HCV in prisons, where it's most common, and it'll be less likely to spread elsewhere.
In a recent study published in the journal Annals of Internal Medicine, researchers argue that this strategy will be cost effective and beneficial for all of society, not just prisoners.
An $84,000 treatment
A full 17.3% of the US prison population has the virus, while it's only found in 1% of the non-institutionalized population.
But as people cycle in and out of jails and prisons, the virus spreads, especially when people aren't aware they have it in the first place.
It's transmitted mostly through exposure to an infected person's blood — usually due to intravenous drug usage — though also through sex and occasionally in other ways. A pregnant woman can pass it on to a child.
Due to new advances, we now have drugs to fight HCV that didn't exist before. Many of those infections could be stopped.
"With the advent of new and highly effective medications, there's a real opportunity to treat this population," Gabriel Eber, a staff attorney with the ACLU's National Prison Project, tells Tech Insider.
Those new drugs are really expensive: One course of treatment with Gilead Sciences' Sovaldi averages $84,000 per patient. But most patients are cured after one course of treatment. Living for ten years with liver disease, meanwhile, costs an estimated $270,000; the costs associated with a liver transplant can be double that, one analysis found.
Providing HCV drugs like Sovaldi to healthcare providers in the prison system would require a big initial investment, but according to the researchers behind the new study, it would be worth it.
'A good investment for society'
In order to figure this out, researchers built a system that modeled the costs of screening for HCV in prisons. They calculated the costs of "opt out" screening, where everyone would be checked who didn't opt out, and compared these results to what would happen if they didn't screen or only screened people deemed to be "at risk" of HCV.
They write in the study that right now, prisons may have an incentive to not screen for HCV, since if they diagnose an illness, they can't ignore it — and treating all the hepatitis infections in prisons would cost a lot. But that means that people who are released are more likely to have no idea of their hepatitis status, which makes them more likely to pass it on.
The researchers found that screening the approximately 2 million people in the prison system and treating those infected would cost just over $1.1 billion in the first year. They also modeled infection rates with people entering and leaving the system.
Assuming all prisoners were screened and treated, both the general population and the prison population would see an immediate decrease in HCV cases, according to their model, as you can see in the charts to the side (or above on mobile).
After 10 years, they calculate, the reduction in the incidence of HCV would save thousands of lives and hundreds of millions in healthcare costs, both in and out of prison.
That's in part because with fewer transmissions and fewer infections, the costs of screening and treating would fall each year, down to $66 million after 15 years, according to their model.
In a 30-year-model, screening and treating the disease would save a net total (counting the costs of treatment) of more than $750 million.
In other words, the researchers say that spending the money would be a cost-effective way of helping stop what they describe as an "epidemic."
However, as they write in the study, "to achieve these benefits, the government needs to provide additional resources to prison health care, which will be a good investment for society."