THE HILL'S FORUM FOR LAWMAKERS AND POLICY PROFESSIONALS
Unfortunately, much of the promising news about the clinical value of the new treatments is increasingly drowned out by concerns – and sensational headlines – about how much those medications cost. Those concerns are overshadowing efforts by federal health agencies who are sounding the alarm about the need for screenings, especially among the most vulnerable, namely the baby boomer generation (those born from1945 to 1965). Too many Americans who should get the simple blood tests required to detect hepatitis C are not getting it.
As a result, too many Americans are and will continue silently living with hepatitis C and dying from it unless screening is increased. Recent research from the Centers for Disease Control and Prevention (CDC) starkly illustrates this fact. Current statistics show that the number of peopleliving with chronic hepatitis C is declining. But part of this decline is due to growing deaths among hepatitis C-infected individuals, primarily adults aged 45-65.The point is this: value counts more than cost. The new treatments for people living with hepatitis C offer a cure to a life-threatening diseases and can prevent liver damage, including liver cancer. And though the current cost of such treatments does run quite high, the benefits of therapy could offset those expenses. The potential long-term equation here is basic: with testing and appropriate linkage to care, new treatments could ultimately not only save lives but also lessen the economic burden of hospitalizations associated with hepatitis C and advanced liver disease.
Consider a telling study published last month in Health Affairs. It found that the rate of hospitalizations associated with hepatitis C infections and advanced liver diseases in the United States increased dramatically – 190 percent – between 2004 and 2011. That increase is likely due to individuals, primarily baby boomers, infected with hepatitis C who developed severe liver disease. In the same eight-year period, medical costs for those hospitalizations grew nearly fourfold, from $900 million to an estimated $3.5 billion.
The study, largely overlooked by mainstream media, reinforces the urgency of this serious national public health issue. We already know hepatitis C is a silent killer, with some three million people in the U.S. currently living with the virus, many of whom don’t know it. We know that as many as 75% of adults infected with hepatitis C are baby boomers. We know the disease is potentially deadly,killing some 17,000 Americans a year. But the CDC researchers conclude that the trend toward worsening outcomes and higher costs for untreated hepatitis C can be reversed.
Still, that promising prediction comes with a major caveat. Those at increased risk for hepatitis C must be screened, and effective treatment for those already infected must be made available.
Other recent research echoes this optimistic outlook. An analysis conducted by the University of Pittsburgh Graduate School of Public Health showed that hepatitis C is on track to become a rare disease by about 2036, and possibly as early as 2026. The project, funded through the National Institutes of Health and published in the Annals of Internal Medicine, likewise comes with a catch. It assumes an ideal scenario: that those at greatest risk get screened and that those infected are treated.
Given the circumstances, I propose a few important next steps:
Track screenings. Despite the hard work of state and local public health departments to implement screening programs, we lack sufficient documented evidence of how many Americans are getting tested, whether that number has increased – and, if so, by how much – let alone any specifics regarding the at-risk baby boomer generation. Such surveillance data would be invaluable to evaluate the extent of the progress we believe is underway and, in the process, better inform our advocacy efforts for ongoing improvement. Unfortunately, surveillance has been woefully underfunded and should be a priority in federal and state budgets.
Overcome stigma. Shame and embarrassment deter some individuals from getting screened. As the World Journal of Gastroenterology pointed out last year, hepatitis C patients with a history of injection drug use “are frequently blamed for acquiring the disease, and viewed as irresponsible, accountable and unworthy.” Indeed, the study found, stigma itself can even “impede the success of diagnosis and treatment.” We must dedicate resources towards better understanding lingering stigma and finding a way to overcome it.
Encourage those at risk to get tested. No imperative carries more weight than this. Increasing screening and linkage to appropriate care will save lives and reduce costs. The bottom line is unmistakable: one-time testing of all boomers would detect an estimated 800,000 undiagnosed hepatitis C cases, and when linked to care would save as many as 120,000 lives. Unless people get screened, though, costs will soar higher still and lives will be lost. As John Ward, who directs CDC's Division of Viral Hepatitis told the National Journal last year, “The earlier the test and treatment, the better.”
We all have the opportunity to take a common disease and make it – and all its attendant costs – a rarity.
Clary is executive director of the National Viral Hepatitis Roundtable, a coalition of more than 250 public, private and voluntary organizations dedicated to reducing the incidence of infection, morbidity and mortality from viral hepatitis in the United States.