Download Slide 1

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 to
Patient 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
[email protected], 202-223-9870 x. 20
 Visit TFAH online at www.healthyamericans.org
