Direct Acting Antivirals for HCV in the Correctional Setting: Effective at a Price: 1140

Purpose: The Georgia prison system currently has 51450 male prisoners aged 20-65y of whom about 60% are African American and 33% are white. Health care costs of $219,819,481 comprise about 20% of the correctional budget. Hepatitis C in this population may be present in more than 15% of inmates. To estimate the costs of treatment for 100 hypothetical prisoners with HCV type 1, we used a Markov model based on the above racial mix. Methods: The outcomes reported in the telaprevir package insert were employed for estimating the number of sustained virologic responses (SVR). Drug costs were obtained from Drugstore.com. The estimated cost of telaprevir for 12 weeks is $49,000. One week of peginterferon alfa 2a costs $664 and a week of ribavirin was estimated at $170. Costs for physician visits, laboratory studies and additional medications were not included. We assumed 15% of patients would stop therapy at week 8 due to side effects (SE). We also assumed no blood cell growth factors would be used. Results: Of the 100 hypothetical patients with HCV without cirrhosis or other major comorbidities, 34 would be white and 60% of them would achieve early rapid virologic response (eRVR) and complete 24 weeks of therapy with 18 (90%) of them achieving sustained virologic response (SVR). This would cost $69,016/subject for a total of $1,380,320. Of the 14 who would not achieve eRVR, 2 (15%) would stop therapy due to SE at week 8 and 1 (7%) would not achieve virus clearance by week 12 and stop the therapy. 11 (78%) patients would be treated for 48 weeks and 7 (50%) of them would achieve SVR at a cost of $89,032/subject (total $1,117,036). Overall, 27 (80%) white subjects would achieve SVR at a total drug cost of $2,497,356. The cost of SVR in a white subject would be $92,494. Of the remaining 66 hypothetical black prisoners, 22 (33%) would experience eRVR and of them 20 (90%) would have SVR at a cost of $1,518,352 for this eRVR group. 44 patients would not achieve eRVR, 6 (15%) would stop due to SE. 3 (7%) would not achieve virus clearance at week 12. 35 would be treated for 48 weeks and 20 (57%) would achieve SVR. The total drug cost for this group would be $5,047,524. The cost of an SVR for a black subject would be $126,188. Conclusion: The use of the direct acting antiviral agents in combination with peg-interferon and ribavirin is a new standard of care. While expensive, these agents can achieve impressive SVR rates in this hypothetical prisoner population at a blended reasonable cost of $112,610. In contrast, 48 weeks of peginterferon and ribavirin would cost $40,032 for 48 weeks per patient and only 46% would achieve an SVR. It is important to recognize however that outcomes outside a trial may be inferior to those projected. Disclosure: Dr Schade: Vertex speakers bureau.