These New Costly Drugs Could End The Hepatitis C Epidemic In Canadian Prisons

The Correctional Service of Canada just added the three breakthrough drugs to its national formulary.

The Canadian government is treating prisoners for a deadly disease with expensive, highly effective new drugs that could finally put an end to epidemic-level infection rates.

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The Correctional Service of Canada recently added three new drugs to its national formulary — its list of approved medications — that have been dubbed breakthroughs in the treatment of hepatitis C.

"These medications are significantly more effective and have fewer side effects than previous treatments," CSC spokesperson Esther Mailhot said in an email.

The correctional service added Sovaldi to its formulary in January, Harvoni in March, and Holkira Pak just this month after the Canadian Agency for Drugs and Technologies in Health recommended them for use across the country.

The new drugs are essentially cures, says Dr. Eric Yoshida, chairman of the Canadian Liver Foundation's medical advisory committee.

“These drugs will basically eradicate the virus in anywhere from 96 to 99 per cent of patients with very little side effects,” he said.

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That's good news for Canada's prisons, which have seen hepatitis C infection rates hover around 30% in recent years due largely to unsafe needle sharing. CSC said the infection rate in 2007 was about 33%. The most recent data the correctional service provided was for 2013, when the rate was around 17%. There are about 15,000 people in Canadian federal prisons.

But the cost of the drugs “is significantly higher than former treatment regimens,” Mailhot said. All three treatments can cost anywhere from $50,000 to $100,000 per 12-week treatment.

Already, the cost to CSC of treating the disease had increased sevenfold between 2005 and 2007 to $4.7 million, the Canadian Medical Association Journal reported.

The cost of the new drugs "will be based on the number of individuals treated," Mailhot said, adding that prisoners can still be treated with older, less effective treatments.

The inconsistency of public coverage of the drugs also creates a situation in which some federal offenders may have free access to the treatments before those living outside prison walls.

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The liver foundation said Sovaldi and Harvoni aren't yet publicly covered in Prince Edward Island, Northwest Territories, and Nunavut, while Holkira Pak is not yet covered in Alberta, Nunavut, Northwest Territories, and New Brunswick.

Howard Sapers, Canada's prison watchdog, said CSC's decision to add the costly drugs to its formulary before some provinces and territories is "perfectly justifiable," though.

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"The question isn't really the narrow question about whether this drug or that drug should or shouldn't be made available if it's not readily available in the community," he said in an interview. "It's really about, what is the purpose of incarceration and what is the responsibility of the state, when the state's made a decision to take away somebody's liberty?"

Both Sapers and Yoshida said they believe CSC — which is mandated by law to provide healthcare to prisoners — will actually save money by investing in the drugs now because of the high cost of long-term care.

Hepatitis C, which affects about 250,000 Canadians, is a chronic liver illness that can lead to cirrhosis (liver scarring) or cancer.

“The long-term cost savings by curing these patients is going to be tremendous,” Yoshida said. “The cost of dying of end-stage liver disease in hospital is huge, it’s literally hundreds of thousands of dollars. Waiting for a transplant that won’t happen because there aren’t enough organs, well that’s huge too.”

Yoshida said the medications, if combined with stopping transmission of the disease through needles, could potentially stem the epidemic in Canada’s prisons altogether.

"I think the impact is going to be huge for the Correctional Service of Canada and the incarcerated patient population," he said.

CSC said the treatments will benefit everyone — not just offenders. "Providing the most effective available medication for offenders with [hepatitis C] will directly contribute to the safety and security of staff and offenders and ultimately the safety of the public," Mailhot said.

Sapers, who has been highly critical of the correctional service and who is set to be replaced by the Conservative government, agreed.

"I don't think we want to see these offenders coming back into the community more ill than they were when they went into prison," he said, adding that access to proper healthcare has been the top type of complaint his office hears.

CSC said it's still too soon to determine the full effect of the new drugs.