According to the Centers for Disease Control (CDC), HCV is responsible for more than 16,000 deaths per year in the United States (more than HIV) and, according to the American Liver Foundation, is also responsible for the majority of the more than 6,000 U.S. liver transplants per year. (Liver transplants cost $575,000 according to the National Foundation for Transplants).
Again according to the CDC (2010), of every 100 persons infected with HCV, approximately:
- 75–85 will go on to develop chronic infection,
- 60–70 will go on to develop chronic liver disease,
- 5–20 will go on to develop cirrhosis over a period of 20–30 years, and
- 1–5 will die from the consequences of chronic infection (liver cancer or cirrhosis).
Advances in treatment of HCV have been consistent and significant. In November 2013, Gilead announced FDA approval for Sovaldi, which is shown to bring about "cure level" therapy in treatment of HCV when used with other antiviral medicines in as few as 12 weeks. We further expect a single dose, all-oral therapy to be available before the end of 2014.
While exponentially simpler than more complicated "cocktails" of pharmaceutical treatment, new drugs like Sovaldi still require excellence adherence to therapy protocols in order to maximize their benefit and justify the high price tag for both patients and insurers.
For the moment, most commercial and government insurers are covering these advanced therapies with proven ability to achieve cure rates for those suffering from HCV. More needs to be done to ensure these new therapies continue to be within reach of those who need them before the disease leads to liver failure and the need for a transplant.
Despite the high volume “noise” in media outlets as to how state Medicaid programs and commercial insurers will manage HCV drugs in future, the majority of plans are currently covering highly effective new treatments. The Prior Authorization process can be cumbersome and individual plans may dictate which pharmacy or medication management company the patient must utilize. However, most patients are indeed accessing new therapies with minimal co-pays (thanks to co-pay programs sponsored by manufacturers and in many cases facilitated on behalf of patients through companies like Curant Health). The widespread use of Sovaldi (as cited in Gilead’s earnings reports) demonstrates current access to the drug by a large number of patients.
The U.S. Department of Health and Human Services maintains an excellent resource related to Hepatitis Testing Day (May 19, 2014) including an online risk assessment tool, Testing Day events, latest testing recommendations and additional resources.
As we roll through Hepatitis Awareness Month, the simple, most powerful message we can convey is, get screened for HCV. New treatments that cure HCV are within reach.
Amy Hampton is HCV program director for Curant Health. Based in Smyrna (Atlanta), Georgia, Curant Health specializes in medication therapy management to improve adherence and outcomes for patients with chronic diseases and the healthcare providers and payors that serve them.