Considerations Decision Makers Use to Decide Pharmacologic Treatment for Patients Infected with the Hepatitus C Virus (HCV) in State Prisons

摘要

Objectives: The objective was to characterize the considerations that state decision makers use to determine which pharmaceutical drug treatments will be made available for use in patients infected with HCV. Newer drug treatments for the hepatitis C virus (HCV) include direct-acting antivirals (DAA). These have demonstrated significantly improved clinical outcomes over conventional treatment, yet are very expensive in the short-term. In the United States, intravenous (IV) drug users are likely to be infected with HCV, and IV drug users are likely to be in state prison.;Methods: The research design of this study was a semi-sequential mixed methods approach. The initial qualitative phase involved a semi-structured interview with a medical director for a state prison system who is involved in determining therapies that are made available to clinicians treating patients with HCV. The interview was used to inform survey development. The survey was distributed nationally to members of the Coalition for Correctional Health Authorities (CCHA) to characterize HCV in state prisons, identify the treatments used for those patients, and assess how financial considerations, among others, impact drug treatment decisions. A purposeful sample of survey participants included one representative decision maker for each state and one for Washington, D.C. Results were collected using Creighton BlueQ. Descriptive and relational statistics were performed using Statistical Package for the Social Sciences (SPSS).;Results: Data collection was completed at the end of October 2017. A 42% response rate was achieved. Twenty-four survey responses were initiated, two were incomplete, and another contained responses that were not informative enough to be included in the final results, yielding a total of 21 surveys included in the final analysis. Among those who responded, all states have a newer DAA available for the treatment of HCV, and all but one of the responders indicated that they are given as the first option. All responders indicated that the therapeutic efficacy, safety, and guidelines such as their state's Medicare guidelines or the Federal Bureau of Prisons (FBOP) guidelines, factor into their decision-making process when choosing drug treatments for HCV, and 11 responders (52%) indicated that financial considerations factor into their decision-making process when choosing drug treatments for HCV.;Conclusions: Results indicated that despite the steep prices of the newer HCV treatments, they are widely available and in use in state prison systems in the states whose decision makers responded.;Implications: What can we further conclude from this finding? What does it mean to the public's health? Are there further policy implications from your finding? The stakeholders first and foremost are the HCV infected inmates, a vulnerable population who is being given access to these novel treatments in these states. The results indicate that a vulnerable population in the United States is being given access to the DAA's drug rehabilitation programs are being enacted, and HCV disease prevention is considered such that HCV prevalence will continue to be low in the United States. Policy changes are thus likely unnecessary since the DAA's are available and given in the state prison system.;Globally, the applications of these findings are even more limited. Every country has their own administrative regions, and, more importantly, their own mechanisms for funding healthcare both for prison populations and the population at large.