March 31, 2017

Here's how the US could end new cases of Hep B, C by 2030

Daily Briefing

The United States could eliminate new cases of hepatitis B (HBV) and C (HCV) by 2030, and, as a result, prevent about 90,000 deaths, according to a report released Tuesday by the National Academies of Sciences, Engineering, and Medicine.

About HBV and HCV

According to MedPage Today, chronic HBV and HCV affect roughly four million U.S. residents. About 20,000 people in the United States die from the diseases annually. The disease spreads via sexual contact and exposure to infected blood. A majority of individuals infected with HBV or HCV are unaware of the infection.

According to the Los Angeles Times' "Science Now," HBV and HCV infection rates are particularly high among prison populations, ethnic minorities, and individuals who use injectable drugs. Injectable drug users account for 75 percent of the approximately 30,500 new HCV cases reported annually in the United States.

Further, Brian Strom of Rutgers University, who lead the expert committee that completed the report, said HBV and HCV contributed to a 38 percent increase in instances of liver cancer in the United States between 2003 and 2012. According to "Science Now," about 2,400 liver transplants annually are related to HBV and HCV.

5 strategic directions to eradicate HBV, HCV

The report outlined steps public health officials would have to take to eradicate new cases of HBV and HCV in the United States. According to the report, both the federal and state governments would have to make those efforts a priority to successfully eliminate the diseases.

Strom said the report is broken down into five "strategic directions":

  1. Identifying which individuals need to be treated for HBV and HCV and where those individuals are located;
  2. Determining which interventions are needed;
  3. Determining how those interventions can be administered in an equitable manner;
  4. Figuring out how the process will be funded, particularly because effective drugs to treat hepatitis C are costly; and
  5. Conducting research on a vaccine for HCV, as well as on a curative treatment for HBV.

Goals for 2030

According to the report, the United States could potentially reduce HBV mortality by 50 percent by 2030, which would avert about 60,000 deaths. To do so:

  • 90 percent of chronic HBV cases would need to be diagnosed;
  • 90 percent of diagnosed patients would have to access care; and
  • 80 percent of patients who need treatment would have to receive it.

If those quotas are met, new cases of HBV-related liver cancer would decrease by about one-third, according to the report, and new cases of HBV-related cirrhosis would decrease by about 45 percent.

The report also stated that the United States could reduce HCV mortality by 65 percent by 2030, which would avert about 28,000 deaths. To do so:

  • 90 percent of chronic HCV cases would need to be diagnosed;
  • 90 percent of diagnosed patients would have to access care; and
  • 80 percent of patients who need treatment would have to receive it.

The report stated that achieving those quotas only would be possible if there are no restrictions—including costs—keeping individuals from receiving breakthrough medications to treat the disease, as well as the ability to identify new cases of HCV as prevalence declines.

Analysis: More doctors are prescribing millions of dollars' worth of medicine under Medicare

"You can't prevent the disease with a vaccine, but you can prevent it by curing it—and curing it in the people who would have passed it on to other people," Strom said.

What the federal government must do to eliminate HBV, HCV

According to Strom, the report called on officials at the "highest level of the federal government" to implement the actions needed to eliminate HBV and HCV. In addition, the report called for:

  • CDC and state and local health departments to improve efforts to identify hepatitis cases, as well as follow-up and monitoring of such cases and linking the cases to care;
  • Efforts to eradicate HBV transmission from mother to child;
  • Incorporating viral etiology in national reports on liver cancer;
  • Increasing access to needle-exchange programs and treatment for opioid-related substance use disorders;
  • Public and private health insurance plans to lift coverage restrictions on HCV drugs;
  • Removing barriers and expanding access to HBV vaccination for adults;
  • Research measuring HBV and HCV infection rates and prevalence in populations at high risk for the diseases; and
  • The criminal justice system follow national clinical practice guidelines for screening, vaccinating, and treating for HBV and HCV;
  • The federal government to purchase the rights to new HCV drugs to ensure individuals in prisons, Medicaid beneficiaries, and individuals who seek care at the Indian Health Service have access to the treatments.

According to the report, it would cost the federal government about $2 billion to purchase the rights to such drugs and about $140 million to provide the medications to about 700,000 patients who currently do not have access to them.

However, the report stated that purchasing rights to the drugs ultimately would save the federal government money, noting the federal government under current practices likely would pay about $10 billion over the next 12 years to treat only a fraction of those patients. The report estimated that purchasing the rights to new HCV treatments could save the United States more than $8 billion by 2030 (Smith, MedPage Today, 3/28; Healy, "Science Now," Los Angeles Times, 3/28; National Academies of Sciences, Engineering, and Medicine release, 3/28).

What providers can learn from the drug pricing debate

We already knew that patients are becoming more sensitive to health care costs. But public uproar over one drug's 5,000 percent "overnight" price hike proves that patients are more discerning—and vocal—than ever. With more of their money on the line, patients are actively deciding when and where to access care based on cost.

We saw it coming—and we laid out concrete tactics for dealing with price sensitivity in your market. The first chapter in our study, The Consumer-Oriented Ambulatory Network, focuses on how you can retain market share by making services more affordable. Download the study to learn more.

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