Pennsylvania prisons this fall will treat about 75% fewer inmates for hepatitis C than they currently treat but will provide more targeted care for hepatitis C patients who are most likely to benefit from treatment, the Philadelphia Inquirer reports. Currently, Pennsylvania has 8,300 inmates with the liver disease and is treating about 550 inmates, at a cost of about $16,000 per patient for a 48-week course of medicine, according to Fred Maue, chief of medical services for the state Department of Corrections. Last year, the department was "over ... budget" for hepatitis C treatment, spending about $8.8 million, Maue said, adding that the most the department could spend on hepatitis C treatment this year is $6 million, and treatment costs will drop even more next year. Under new guidelines, which go into effect in September, the state will apply stricter criteria for treatment, with about 130 inmates each year receiving treatment. That number may eventually be cut to less than 100 inmates, although the number of inmates with hepatitis C likely will remain constant, at about 23% of the state's prison population, according to Maue. He added that treatment would be limited to inmates with a highly treatable form of hepatitis C, which affects about 15% of people with the disease. In order to be considered for treatment, inmates will have to have at least 18 months remaining in their sentences, up from one year, and will have to undergo a liver biopsy.

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"It's to the patients' benefit to be more focused," Thomas Shaw-Stiffel, a specialist at Pittsburgh's Center for Liver Diseases at the University of Pittsburgh Medical Center Health System, said, adding that "on the surface, (the reduction) may look ominous, but it may be beneficial." Angus Love, director of the Pennsylvania Institutional Law Project, said, "It's disappointing" but added that "[i]t's not surprising, given the [state's] budgetary constraints." The reduction in treatment access for inmates comes at a time when hepatitis C medications are more effective than ever (Fazlollah, Philadelphia Inquirer, 7/24). The new drugs -- pegylated interferon combined with ribavirin -- cure approximately 50% to 60% of people with aggressive strains of hepatitis C and about 80% to 90% of people who have less aggressive strains of hepatitis C, according to Shaw-Stiffel. "The problem with hepatitis C is there's nobody to pay for [inmates'] meds after they're out of prison," Dr. Richard Greifinger, a CDC consultant, said, adding, "It's actually dangerous for the patient, I think, to have an incomplete treatment." Government assistance programs cover the costs of antiretroviral drugs to treat HIV infection, which also disproportionately affects the prison population, but drugs to treat hepatitis C are not covered by similar programs (Mandak, Associated Press, 7/23).

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