Reports

HBV & HCV: America’s Hidden Epidemics

September 2010

The American Association for the Study of Liver Diseases (AASLD) and the Trust for America’s Health (TFAH) issued a report in September 2010 calling for action to be taken to transform how the country deals with viral hepatitis – to help identify millions of Americans who know they are living with chronic forms of hepatitis B and C and to assure access to treatment for all who need it, to prevent even more Americans from becoming infected.

“This report is a critical next step that builds on  a recent groundbreaking Institute of Medicine report on viral hepatitis and translates it into a series of action items which will be critically important to control the silent epidemic of viral hepatitis in the US,” said Arun J Sanyal MD, President of AASLD.

The report, HBV & HCV: America’s Hidden Epidemics, examines how new measures included in the Patient Protection and Affordable Care Act (ACA) combined with new scientific advancements could be used to spare millions of Americans from developing cirrhosis, liver cancer, or other life threatening complications as they age – which could also lead to billions of dollars in health care savings.

“HBV and HCV are ticking time bombs.  If we don’t act now to diagnose the millions of Baby Boomers and others, we’ll be too late to spare them from developing serious liver diseases.  We’ll all end up paying the price, since Medicare and Medicaid will end up picking up the tab for much of the care,” said Jeff Levi, PhD., Executive Director of TFAH.  “Health reform and new science give us a once-in-a-generation opportunity to rethink how we deal with these silent killers.”

Some key findings in the report include that:

• An estimated 65 to 75 percent of the five million Americans currently infected with the hepatitis B virus (HBV) or hepatitis C virus (HCV) do not even know they have the virus;
• The Institute of Medicine (IOM) estimates that 150,000 Americans could die from liver cancer or end-stage liver disease associated with hepatitis B virus (HBV) or hepatitis C virus (HCV) in the next decade;
• The death rate from HCV is expected to triple in the next 10 to 20 years;
• An independent analysis found total medical costs for HCV patients could more than double over the next 20 years – from $30 to $80 billion per year;
• Liver cancer treatment can be more than $62,000 for the first year cost and the first-year cost of a liver transplant can be more than $267,000;
• Two-thirds of HCV cases are Baby Boomers – and if they are left untreated, it could lead to a major increase in upcoming Medicare spending;
• One in 10 Asian and Pacific Islander Americans are estimated to have a chronic HBV infection;
• An estimated 540,000 to 858,000 African Americans are estimated to have a chronic HCV infection;
• Approximately 800 to 1,000 infants in the United States are infected with HBV at birth each year; and
• At least 100,000 patients have been notified about potential exposure to HBV, HCV, and/or HIV while receiving health care since 1998.

Some highlight recommendations from AASLD and TFAH in the report include:

• HBV and HCV screening and HBV vaccination should be the standard of care in the reformed health system;
• All pregnant women should be screened for HBV and appropriate health measures should be taken to prevent perinatal transmission from infected mothers to their newborns.  All newborns should receive their initial (birthdose) of hepatitis vaccine within twelve hours of birth;
• Every person diagnosed with HBV or HCV should have access to and receive a minimum standardized level of care and receive support services;
• Strong public education campaigns and improved surveillance must be put in place to help prevent new infections;
• Policies must be established to ensure that health care associated hepatitis infections are treated as a “never event;” and
• The investment in hepatitis-related biomedical and behavior must be significantly increased – and should be more proportionate to the public health threat associated with hepatitis.