Okla lahoma oma De Depart rtment ment of Co f Corr rrecti - - PowerPoint PPT Presentation

▶
okla lahoma oma de depart rtment ment
SMART_READER_LITE
LIVE PREVIEW

Okla lahoma oma De Depart rtment ment of Co f Corr rrecti - - PowerPoint PPT Presentation

Oct 13, 2023 115 likes •279 views

Okla lahoma oma De Depart rtment ment of Co f Corr rrecti ctions ons Hepati atiti tis s C OKLAHOMA DEPARTMENT OF CORRECTIONS http://doc.ok.gov Hepatitis C Prevalence: Percentages Infected with Hepatitis C 18 16 14 12 10 8 6

slide-1
SLIDE 1

Okla lahoma

  • ma De

Depart rtment ment

  • f Co

f Corr rrecti ctions

  • ns

Hepati atiti tis s C

OKLAHOMA DEPARTMENT OF CORRECTIONS http://doc.ok.gov

slide-2
SLIDE 2

Hepatitis C Prevalence:

Percentages Infected with Hepatitis C

2 4 6 8 10 12 14 16 18 General Public 1% National Prison Average 17% Oklahoma Prison Average 12%

slide-3
SLIDE 3

HCV Chronic Clinic Data FY 2013-2019

FY 2013 FY 2014 FY 2015 FY 2016 FY 2017 FY 2018 FY 2019 19-Sep Inmates with HCV 1,578 2,093 2,179 2,276 2,544 3,038 3,107 3,118 500 1,000 1,500 2,000 2,500 3,000 3,500

Hepatitis C Inmates Enrolled in Chronic Clinic

slide-4
SLIDE 4

Intake Screening:

Initial Physical Examination and Laboratory Requirements:

Medical, dental and mental health screenings are conducted by a qualified health care professional on all inmates upon arrival at the assessment and reception center

  • Complete Blood Count test (CBC)
  • Comprehensive Metabolic Panel test (CMP)
  • Cholesterol/Lipid Profile
  • Tuberculin Skin test
  • HIV/STD test
  • For female inmates: pregnancy test and if 40 or
  • lder, mammography.
slide-5
SLIDE 5

How We Screen: Hepatitis C

Evaluation and management of HCV includes 5 basic steps:

  • Step 1: Test for Hepatitis C Infection.

Per current policy, HCV testing is initiated as a result of a physician’s request due to identified risk factors, (exposure to bloodborne pathogens, e.g., tattooing, needle sticks, etc.)

  • r inmate request.
slide-6
SLIDE 6

How We Treat:

  • Step 2: Perform a baseline evaluation of inmates

who are HCV positive:

  • Targeted history and physical exam
  • Lab tests and ultrasound
  • Step 3: Assess for hepatic cirrhosis/compensation

and priority criteria for treatment:

  • Evidence of Liver Fibrosis/Cirrhosis
  • APRI and FIB-4
  • Comorbidities
slide-7
SLIDE 7

How We Treat:

  • Step 4: Perform a pretreatment exam. If priority

criteria for treatment are met:

  • Agreement for Treatment
  • Patient Education
  • Initiate DAA Regimen
  • Step 5: Monitor patient during and after

treatment:

  • Nurse Monitoring Twice Monthly
  • Post-Treatment Lab Requirements
slide-8
SLIDE 8

How We Treat: The Medications Used

Direct Acting Antivirals (DAA) currently on the market have a greater than 90% cure rate for Hepatitis C.

  • Epclusa (sofosbuvir/velpatasvir) 12 week course (1

tablet daily) $23,219.37, approximately $276.43 per day

  • Mavyret (glecaprevir/pibrentasvir) 8 week course

(3 tablets daily)$29,539.29, approximately $527.49 per day

slide-9
SLIDE 9

How We Treat: The Medications Used

  • Zepatier (elbasvir and grazoprevir) 12 week course

(1 tablet daily) $13,206, approximately $157.22 per day

  • Vosevi (sofosbuvir, velpatasvir, and voxilaprevir)

12 week course (1 tablet daily) $62,080.77, approximately $739.06 per day

slide-10
SLIDE 10

Consequences of Not Treating Hepatitis C:

Hepatitis C is treatable. Over time, failure to treat Hepatitis C could cause the following complications:

  • Cirrhosis
  • Liver damage
  • Chronic liver disease
  • Esophageal Varices
  • Hepatic Encephalopathy/Liver Failure
  • Liver Cancer
  • Death
slide-11
SLIDE 11

Hospitalization Caused by Hepatitis C

Lindsay Municipal Hospital: FY 2018

$389,830.76 $74,139.69 $528,039.13 $50,398.33 $25,000.00 $125,000.00 $225,000.00 $325,000.00 $425,000.00 $525,000.00 Cirrhosis Chronic Liver Disease Hepatitis C Liver Cancer

slide-12
SLIDE 12

Hepatitis C Public Health Considerations

  • Target and provide treatment to inmates infected with Hepatitis C.
  • Statistics show 95 percent of all inmates will eventually be
  • released. Treating the infected inmate population can stop the

spread of the disease and improve public health.

  • The CDC states improved access to medical care and prevention

services for incarcerated populations can benefit communities by reducing disease transmission and medical costs.

  • Primary prevention of HCV is directed at lowering the rate of HCV
  • infection. Prevention should be aimed at those individuals who

engage in the high risk activities for transmission behaviors, such as the inmate population.

slide-13
SLIDE 13

Cost of Hepatitis C Treatment

Hepatitis C Drug Cost FY 2016-FY 2019 FY 2016 FY 2017 FY 2018 FY 2019 yearly cost $259,907.13 $419,112.79 $740,041.16 $1,109,296.28 $0.00 $200,000.00 $400,000.00 $600,000.00 $800,000.00 $1,000,000.00 $1,200,000.00

slide-14
SLIDE 14

Hepatitis C: Future Cost Considerations

  • From July 1-August 31, the agency has spent

$1,447,745.80 of the $12 million provided in the FY 2020 budget on Hepatitis C treatment. It is anticipated that we will expend and possibly exceed the current funding.

  • Numerous states have had legal action taken

against them regarding inmate access to HCV treatment.

slide-15
SLIDE 15

Future ODOC Considerations

Opt Out Testing

  • ODOC has developed a draft policy to incorporate an

“opt-out” screening as part of the assessment and reception process. If initiated, an HCV antibody test would be performed on all inmates at the point of reception.

  • The HCV antibody lab panel is approximately $8.00 per
  • lab. Approximately 10% of arrivals will test positive for

Hepatitis C and will require confirmatory HCV-RNA testing at a cost of $75.00 per test. Based on current reception rates, it is estimated that $175,000 of FY 2021 funding would be dedicated to this screening.