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| Interferons on a budget |
| By Sarah Etter, News Reporter |
| Published: 10/23/2006 |
When the Centers for Disease Control released its guidelines for the prevention and treatment of Hepatitis C two years ago, the North Dakota Department of Correction and Rehabilitation faced a health problem that came with a hefty price tag.“This is one expensive disease to treat,” says NDDOCR Medical Director Jeff Hostetter. “Most of the people who need Hep C treatment are usually alcoholics or drug users, and in prison, it's a real problem because we have a much higher concentration of that population.” Roughly 6.3 percent of the agency's population has been diagnosed with the virus, and it is responsible for treating all long-term offenders. But Hep C treatment can cost, on average, upwards of $21,165 annually per inmate. For ND's 1,300 Hep C positive inmates that's a hefty $275,145 yearly bill. Just like North Dakota, many DOCs are struggling to provide equal treatment to all infected inmates without draining their annual budgets. The virus, which is transmitted through intravenous drug use or contact with infected blood, can cause liver inflammation and often occurs without symptoms. Treatment is largely based on interferons, a class of natural proteins produced by the cells of the immune system to fight infections. Once doctors discover how Hep C is affecting an individual, they can determine how much interferon-based therapy an offender needs to help repair damage caused by the virus. North Dakota initially used a Peg-Interferon treatment, which is normally administered through injection once a week. However, this therapy has been known to cause many side effects like bone marrow disease, anemia and thyroid poisoning. Treatment to then address these side effects usually adds another $5,000 to $8,000 per offender. When the costs began piling up, North Dakota looked to Johns Hopkins University, where research showed success with another interferon known as Consensus Interferon. While similar to Peg-Interferon it did not have as many harsh side effects. “I feel like many people don't know about the Consensus Interferon, so they keep using the Peg-Interferon,” says NDDOCR Director of Medical Services Cathy Bachmeir. “It hasn't been widely publicized, but we've been seeing excellent results.” Bachmeir says she is conducting traditional research on the drug because of its FDA approval and about 17 inmates are currently undergoing the Consensus therapy. After 18 months, she says officials are seeing positive results. Other studies, especially ones from Canada, indicate that Consensus is equally, if not more, beneficial than Peg-Interferon during HEP C treatment. “It turns out that for Consensus, we're actually seeing much better results. From what we've seen, the drug companies that are pushing the Peg-Interferon are wrong,” Hostetter says. “They tend to make it seem like nothing works as well, but we've seen the exact opposite.” The potential side-effect of thyroid poisoning from Consensus Interferon does exist, but treating the thyroid while being able to avoid bone marrow complications and anemia is a big help for DOC wallets. Consensus therapy costs about $13, 681 per inmate, which Hostetter says, lets the NDDOCR treat twice as many inmates because of the cheaper price. “This is definitely an option for DOCs,” Hostetter. “From what I see in my patients, if I needed to be treated for Hep C personally, I would use the Consensus Interferon. The only real issue is that it has to be administered three times a week instead of once, but in prison that's not an issue because we just find the offenders and give them their shots.” Hostetter thinks three injections weekly is not much of a drawback. “It's better to give people three shots than give them a more toxic medication,” he adds. Hostetter and Bachmeir both emphasize the importance states to follow the example of North Dakota medical experts by conducting their own research before deciding what treatment is best for them. “Being good stewards of the state's money, we can get more accomplished with the Consensus Interferon,” says Bachmeir. “We did lots of literature reviews and studies, and wrote down all of the pros and cons before we started this program.” NDDOCR officials also ran the idea past their Attorney General to ensure that they had government backing before they introduced Consensus to the inmate population. “We wanted to make sure the [Attorney General] knew what direction we were going in. We have a general council just so he knows what we're doing and how we're doing it, so we gave him all the info and we got the go ahead. We started this program small and now it's all we use.” Bachmeir explains. The Consensus Interferon might not be a cure all, but North Dakota corrections health practitioners are hailing the treatment as a cheaper alternative that can provide better results than other options. Bottom Line: Consensus Interferon could save state's money without compromising inmate care. By doing more research and understanding the interferon therapy used, they may be able to provide more treatment for less cost. Dr. Jeff Hostetter can be reached at jhostett@medicine.nodak.edu for more information. |
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