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A stealthy killer, hepatitis C needs wider screening
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Published Sunday July 15, 2012
NYC has instituted the first large scale urban hepatitis C screening project, this $2 million pioneers linkage-to-care with trained patient navigators plus new rapid HCV screening, and weekly web-based training/case reports by expert clinicians for community-based selected care sites' clinicians throughout NYC.
"We predicted that, compared with the status quo, birth-cohort screening would identify an additional 808 580 cases of HCV infection and prevent 82 000 HCV-related deaths, at a cost of $2874 per new case identified and $15 700 per QALY saved assuming standard treatment and $35 700 per QALY saved assuming DAA with standard therapy. Birth-cohort screening seems to be a reasonable strategy to identify asymptomatic cases of HCV."
Global Burden of Hepatitis C: Considerations for Healthcare Providers in the United States - (06/20/12)An estimated 2%-3% of the world's population is living with hepatitis C virus (HCV) infection, and each year, >350 000 die of HCV-related conditions, including cirrhosis and liver cancer. The epidemiology and burden of HCV infection varies throughout the world, with country-specific prevalence ranging from <1% to >10%.....Globally, an estimated 130-170 million persons are living with hepatitis C virus (HCV) infection.....The global picture directly impacts the United States; tens of millions of foreign-born persons reside in the United States, many of whom are from countries where HCV infection is endemic (eg, countries with an HCV prevalence ³2%), and >1 million new immigrants enter the United States annually. Therefore, US healthcare providers who treat immigrants and foreign-born persons must recognize that decisions to screen these patients based on established risk factors for HCV infection in the United States [3, 4] may not be sufficient to identify at-risk individuals. Identifying persons with HCV infection has become even more critical with the recent availability of more effective therapies. Providers
HCV Research: new HCV drugs coming; interferon-free therapy - (07/13/12) small studies shoe 90-100% cure rates with new interferon-free multiple new oral drug regimens
By Bob Glissmann
WORLD-HERALD STAFF WRITER http://www.omaha.com
If you're a baby boomer, it's possible that you're walking around with hepatitis C and you don't know it.
Especially if you had a blood transfusion before mid-1992 or shared a needle to inject street drugs, hormones, vitamins or steroids Ñ even once Ñ at some point in your youth.
Who should be tested?
The Centers for Disease Control and Prevention defines the baby boom generation as people born from 1945 through 1965. The U.S. Census Bureau has a narrower definition: those born from 1946 through 1964. The CDC estimates the number of people who potentially could be tested for hepatitis C at 78.8 million. The Census Bureau's estimated number of people ages 47 to 65 as of this time last year was closer to 76.9 million.
The fact that more than 2 million baby boomers are infected with the virus, more than 15,000 Americans die from hepatitis C-related illness every year, and such deaths are up and are projected to rise even more is why the U.S. Centers for Disease Control and Prevention has proposed that all people born between 1945 and 1965 be tested for hepatitis C.
The viral infection can cause severe liver diseases, including cancer. End-stage liver disease, or cirrhosis, because of chronic hepatitis C is the leading cause of liver transplants in the United States.
The CDC is expected to issue a final recommendation later this year.
From a health standpoint, "you'd have to be blind not to agree with it," said Dr. Mark Mailliard, a University of Nebraska Medical Center hepatitis expert. The CDC said the testing could identify more than 800,000 people who have the virus and prevent more than 120,000 deaths.
"The prevalence of chronic hepatitis C is relatively high in the '45 to '65 birth cohort," said Thomas Hoerger, a medical economist with RTI, an independent, nonprofit institute that provides research and other services to government and commercial clients. That, he said, is due in part "to the fact that this group grew up when there was less control over blood transfusions, in that blood wasn't tested for viruses like hepatitis C or for HIV during the period. And there was more intravenous drug use going on."
Symptoms of chronic hepatitis C can take up to 30 years to develop, the CDC says, yet damage to the liver can occur during that time. When symptoms do appear, officials say, they often are a sign of advanced liver disease.
Symptoms for both acute and chronic hepatitis C can include fever, fatigue, loss of appetite, nausea, vomiting, abdominal pain, dark urine, gray-colored stools, joint pain and jaundice.
Many cases of hepatitis C were detected after the 9/11 terrorist attacks, when the country saw a surge in blood donations from first-time donors, said Shane Scharer, Iowa's adult viral hepatitis prevention coordinator.
Donated blood is screened for hepatitis C and other infectious diseases, the American Red Cross says, and any blood that does not pass all lab tests is destroyed.
That doesn't mean that someone seeking a hepatitis C screening should donate blood, Scharer said.
The CDC recommends that people be screened for hepatitis C by physicians who can refer them to a specialist if the test detects the virus. Blood centers don't necessarily do that.
Testing millions of middle-aged Americans for hepatitis C will, of course, cost money. The CDC said testing all baby boomers would cost an estimated $2.3 billion. That cost would be paid by private insurers, through government programs or by the patients themselves.
"At this point everybody's sharpening their pencil and getting out their calculator, looking at costs and benefits," said Dr. Tom Safranek, Nebraska's state epidemiologist. "I would say right now the jury is totally out whether or not this is going to be a 'go' or not."
Testing and treatment, the CDC said, could avert $2.5 billion in medical costs related to the treatment of liver cancer, liver transplants and liver disease.
By itself, that would represent a savings.
But you also have to figure in the cost of the treatment for those found to have the disease.
The newest treatment regimen for hepatitis C, which rids the patient's body of the virus about 75 percent of the time, costs about $60,000 per patient, the CDC says. A report published in the November issue of the Annals of Internal Medicine estimated that nearly 41 percent of the 800,000 newly identified people with the virus would be treated, costing more than $19 billion.
Hepatitis C: The End of the Beginning and Possibly the Beginning of the End - Editorial - (02/22/12)
The Increasing Burden of Mortality From Viral Hepatitis in the United States Between 1999 and 2007: HCV had superseded HIV as a cause of death in the United States, Hepatitis Receives Little Attention/Funding - (02/22/12) "few diseases of such morbidity and mortality in the United States have received so little public attention and funding as chronic viral hepatitis"......"HCV had superseded HIV as a cause of death in the United States.......the relatively young age of most HCV-infected persons who are dying (that is, 45 to 64 years of age) portends a large and ever-increasing health care burden....In 2007, the greatest proportion of HBV- and HCV-related deaths was among persons aged 45 to 54 and 55 to 64 years; 59.4% of HBV-related deaths and 73.4% of HCV-related deaths occurred in these relatively young age groups......screening efforts that target middle-aged persons may be profitable
The Cost-Effectiveness of Birth-Cohort Screening for Hepatitis C Antibody in U.S. Primary Care Settings - "Birth-cohort screening for HCV in primary care settings was cost-effective" (02/22/12) Compared with risk-based screening, birth-cohort screening increased QALYs by 532 000, medical costs by $19.0 billion, and productivity losses due to therapy by $6.7 billion....."Without new case identification strategies, the adverse consequences of chronic HCV infection are forecasted to result in an increasing public health burden over the next 2 decades. Deaths from HCV are forecasted to double to more than 18 000 per year by 2020 and to more than triple to 35 000 per year by 2030.......Birth-cohort screening with DAA plus standard treatment increased screening, cases identified, and persons treated by the same amount as did birth-cohort screening with standard treatment, but (compared with risk-based screening) increased the number of patients achieving an SVR by 311 000 and reduced the number of deaths from HCV to 470 000 (a reduction of 121 000 deaths compared with risk-based screening)
New Cost Effectiveness Study Published: HCV Protease Inhibitor Triple Therapy Cost Effective, Saves Lives..... Universal treatment led to greater benefit but at higher cost - (02/22/12)
Analysts use a measure called quality-adjusted life-years to determine the value of a given medical treatment, Hoerger said. The measure takes into account both the years of life that are saved and the quality of those years. Anything under $50,000 per quality-adjusted life-year, Hoerger said, is considered preferable.
The hepatitis C testing, according to the report published in November, would come in at $35,700.
Still, the screening will increase overall health care costs, Hoerger said.
"But that's the case with almost all types of medical treatment," he said. "We hope that prevention is going to save so much that it pays for itself. It usually doesn't, but it provides better outcomes. ... We're willing to pay more for those better outcomes."
Not everyone who tests positive for hepatitis C will need treatment. Follow-up testing with a physician would be needed to confirm whether the person was currently infected or had had it at some point and naturally cleared it from his or her system, said Jude Dean, Nebraska's viral hepatitis prevention coordinator.
"If you clear that infection, which you can do, you'll still have antibodies that show you were infected," she said.
People with chronic hepatitis C should be monitored regularly by a physician, the CDC says. They should avoid alcohol because it can cause additional liver damage. They also should check with a health professional before taking any prescription pills, supplements or over-the-counter medications, as they could damage the liver, the CDC says.
If liver damage is present, the person should check with his or her doctor about getting vaccinated against hepatitis A and hepatitis B.
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