Treatment challenges fuel the silent hepatitis C epidemic
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The United States has reached a critical point in the hepatitis C epidemic: the virus affects at least 3.5 million Americans. Chronic hepatitis C infection is now the leading cause of liver cancer and it causes more deaths than any other blood-borne infectious disease. Untreated, the virus can destroy the liver’s ability to filter blood and produce proteins that protect our bodies from infection.

Many people don’t even realize they have hepatitis C, as the infection can go for decades without causing any symptoms. People who are infected can transmit infection to others through exposure to their blood. The primary treatment for hepatitis C infection, until very recently, was interferon therapy, which requires months of treatment and is brutally toxic, and not always effective.

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Over the last decade, infection control measures have dramatically changed. Blood is now screened for hepatitis C virus to prevent infection from transfusions. As a result of improved screening tests, we know that somewhere between 2.7 and 3.9 million Americans have a chronic hepatitis C infection. Most of those infected are baby boomers, but rates are increasing fastest among young adults, due in large part to the opioid epidemic and the resulting increase in injection drug use and needle-sharing.

 

In 2013, the FDA approved the first treatment in a new class of drugs that is over 90 percent effective in curing most hepatitis C infections. Some of the new medications require just one pill a day for three months and have no serious side effects for most people. Early treatment can prevent liver cirrhosis and avert the high costs of a liver transplant. And curing hepatitis C can prevent the infection from spreading further.

Today we have more knowledge about the disease, and more urgency, superior treatment, and excellent long-term public health and economic arguments for testing and treating more people.

We have the opportunity now to turn things around if we want to eliminate this disease. There are millions of Americans living with this potentially fatal virus, but fewer will suffer if we implement a screening system to diagnose infections and make treatment available for everyone. However, one of the largest barriers we face in stopping this epidemic is, simply, money.

Money is needed to screen baby boomers and other high-risk groups. As a result, only about half of those who are infected know it, and for too many people, the diagnosis comes after serious liver damage has already been done.

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An even more significant obstacle is the cost of treatment, which can run as high as $150,000 per patient. According to a recent study, it would require an additional $65 billion over the next five years to treat everyone who could benefit from treatment at the current drug prices. That is almost three times the entire Medicaid budget of Texas and about 50 times the Medicaid budget of Alaska.

 

Because of the high cost of curative treatment, most private insurers, and the Medicaid programs in most states, will not cover the drugs until the liver disease is advanced. As a result of this lack of screening and coverage, only about 9 percent of those infected have been treated with the new drugs.

Centers for Disease Control and Prevention (CDC) estimates that comprehensive screening of baby boomers alone could diagnose 800,000 new cases and save 120,000 lives.

The pharmaceutical companies that developed these extraordinary drugs deserve credit and profit for their effort, but it is also incumbent on them to collaborate with insurers and governments to make sure that people who can be cured will be cured. In fact, a recent report from the National Academies of Sciences, Engineering, and Medicine outlines a strategy by which we can lower the cost of treatment through public and private collaboration.

If we can solve these problems, we can achieve one of the great health victories of the 21st century. We can eliminate hepatitis C. If not, we are condemning too many people to shorter, unhealthier lives.

 

Jay C. Butler, MD, is the chief medical officer and director of the Division of Public Health at the Alaska Department of Health and Social Services, and serves as president of the Association of State and Territorial Health Officials (ASTHO). David L. Lakey, MD, is the chief medical officer and associate vice chancellor for population health at the University of Texas System, and previously served as ASTHO’s president in 2011-2012 and as commissioner of the Texas Department of State Health Services. 


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