HBV and HCV: America’s Hidden Epidemics

Jeffrey Levi, PhD

Trust for America’s Health

October 14, 2010

Who We Are

Trust for America’s Health (TFAH) is a non-profit, non-partisan organization dedicated to saving lives by protecting the health of every community and working to make disease prevention a national priority.

Goals of the Report Follow-on to IOM report Concrete strategies for federal action Unique opportunities right now through

Affordable Care Act and scientific breakthroughs

Overview of Problem There are a number of unique challenges that must

be addressed when combating the hepatitis B virus (HBV) or hepatitis C virus (HCV), including: health complications that take decades to develop; significant social stigmas connected to the viruses; disproportionately impacts racial, ethnic and sexual

minorities; and infectious disease prevention strategies have traditionally

been siloed.

Key Findings Nearly two percent of the U.S. population may have

some form of the disease – and approximately five million of these individuals will develop a chronic form of the diseases.

An estimated 65 to 75 percent of the five million Americans currently infected with HBV or HCV do not even know they have the virus.

Impacts on Diverse Populations Of the more than five million Americans with HBV

or HCV: Baby Boomers account for two-thirds of HCV cases - and

if left untreated, it could lead to a major increase in upcoming Medicare spending;

African Americans account for 22 percent of HCV cases; Asian and Pacific Islander Americans account for 50

percent of HBV cases; and Gay and bisexual men account for 15 percent to 25

percent of new HBV cases and are at increased risk for HCV infection.

Once-in-a-Generation Opportunity New prevention options and

treatment possibilities due toPatient Protection and Affordable Care Act (ACA).

Scientific breakthroughs will make treatment, vaccination easier.

Key Recommendations Tracking hepatitis to better target

prevention and treatment efforts: Build on existing HIV surveillance systems;

strengthen state and local networks Focus on tracking both cumulative cases and

emerging outbreaks

Assure that emerging electronic health record system collects appropriate hepatitis-related data

Better tracking of new outbreaks

Key Recommendations HBV and HCV screening and HBV

vaccinations should be the standard of care in the reformed health care system: Screen based on risk factors and age

Make this part of initial Medicare visit and essential health benefit under health reform

Reach out to non-traditional settings HBV vaccination should be encouraged as part of

the preventive benefit under health reform and monitored through electronic health records

Key Recommendations Improve treatment by ensuring everyone who is

diagnosed is linked to care and receives the standard of care: Appropriate coverage and reimbursement for treatment Public-private treatment guidelines updated regularly Plans under Exchanges as well as Medicare and Medicaid

required to meet treatment guidelines and have networks with qualified providers of hepatitis care

Improve referral systems Expand access to wraparound services, perhaps through

Ryan White Program

Key Recommendations Assure adherence to treatment:

Treatment requires a continuum from point of screening throughout care

Provide appropriate culturally and linguistically sensitive support services

Special consideration for marginalized populations

Key Recommendations Prevent New Infections:

Eliminate newborn HBV infections CMS-CDC joint initiative

Eliminate health care-associated HBV and HCV infections

Promote universal HBV vaccination Bolster prevention campaigns and public awareness

Key Recommendations Strengthen research agenda:

Single dose HBV vaccine; develop HCV vaccine; simplify treatment options; rapid tests

Funding proportionate to public health risk NIH funding for hepatitis research is ~$150 million

The cost of doing nothing 150,000 Americans could die from liver

cancer or end-state liver disease (IOM) Medical costs for HCV patients could double

over the next 20 years from $30 billion to $80 billion (Milliman) Many of these costs will be borne by Medicare

and Medicaid A comprehensive approach that includes early

diagnosis and treatment can reverse this trend

Questions?

Please contact: Dara Lieberman, Government Relations Manager

dlieberman@tfah.org, 202-223-9870 x. 20 Visit TFAH online at www.healthyamericans.org