Thursday, January 28, 2016

Hepatitis C Treatment


The 2016 Legislative Session has arrived. This is one in a series of posts from the staff of the New Mexico Corrections Department. We intend to send a daily update to all our legislators with key points, facts, figures, personal stories describing life here at NMCD.

how many inmates have hepatitis c?
There are approximately 3,125 inmates with Hepatitis C; roughly half of the inmate population.

What are the costs involved in treating one individual who has Hepatitis C?*
New oral treatment reports fewer side effects and, in certain cases, a 90% - 98% cure rate of patients. Different genomes require differing treatments and drugs. Costs vary dramatically from drug to drug. For example, those with Genotype 3A could be treated for 24 weeks at a cost of $288,000 per person. Those with Genotype 1 could be treated for 12 weeks at a cost of $69,000 per person.

Due to the ambiguity of both the inmate growth projections provided by the NM Sentencing Commission and the cost to treat Hepatitis C, which varies depending on type, the Department has requested a supplemental appropriation in FY16 of $10 million.
How many patients have you treated/planning on treating?

From July, 2015 to early January, 2016, NMCD has treated 26 patients. Of those 26, the virus is now undetectable in 9. In FY17, NMCD is projecting to treat 150 people.
what is project echo, and how is nmcd involved?

In July 2015, NMCD joined with Project ECHO to collaborate on treatment for Hepatitis C. Project ECHO (Extension for Community Healthcare Outcomes) is a collaborative model of medical education and care management. The ECHO model™ does not actually “provide” care to patients. Instead, it dramatically increases access to specialty treatment in rural and under served areas by providing front-line clinicians with the knowledge and support they need to manage patients with complex conditions such as hepatitis C via Tele-Echo clinics. It does this by engaging clinicians in a continuous learning system and partnering them with specialist mentors at an academic medical center or hub. From a prevention perspective, Project ECHO also educates within facilities so that inmates can help spread awareness to peers regarding the transmission of infectious diseases, including Hepatitis C.

how is treatment determined?

NMCD’s goal is to utilize evidence-based treatment for NMCD inmates infected with Hepatitis C, while at the same time being prudent financial stewards of New Mexico taxpayer money.

We utilize the Indigent Community Standard of Care and consistent with:

§  Project ECHO (University of New Mexico),

§  American Association for the Study of Liver Disease (AASLD),

§  The Infectious Disease Society of America (IDSA)

§  The Federal Bureau of Prisons

Based on existing resources, it is our goal to treat the sickest among us first. Treatment plans are developed in conjunction with Project ECHO. We treat based on the existing community indigent standard of care. Within the NMCD, once a patient has completed the medical screen and appropriate labs/other diagnostic studies, the patient is presented to a panel of subject matter experts via the University of New Mexico Project ECHO specialists. Treatment is initiated and the patient is monitored based upon evidence based guidelines. There is a weekly conference between Corizon Health providers and the members of the Project ECHO team to discuss tentative candidates, and to monitor treatment progress of those individuals who have been initiated on treatment.         
Costs vary. These are rough / estimated figures.     


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