Hepatitis C is an enormously common disease that is often initially asymptomatic. New drugs are very effective, but expensive, and there has been reluctance to cover these treatments. Authors that published research in the hepatitis C special issue present their findings.
Jay Bhattacharya, MD, PhD, opens up the hepatitis C virus (HCV) briefing, which highlighted research published in The American Journal of Managed Care's special issue on HCV. He provided a brief overview of the scope of HCV infection in the US and around the world, as well as the reluctance on the part of payers to cover the expensive drugs, even though they essentially cure the disease.
Bhattacharya served as the guest editor of the special issue, gave short summaries of some of the papers that would be presented at the briefing, and introduced the speakers.
Darius Lakdwalla, PhD, gave attendees a better understanding of "the dismal science of economics" as it relates to the HCV cures. Since hepatitis C is largely asymptomatic for a number of years, it takes a while for the benefit of treatment to accrue, he explained.
"If you compare people who are successfully treated, essentially cured with no viral load in their body, and compare them to other people with hepatitis C, who still are infected with the virus, over the first couple of years there's not a really big difference in death rates among those 2 populations," he explained.
It takes about 15 years or more to start to see a difference, Lakdawalla said. Unfortunately, many of the people infected with HCV are covered by private insurance or Medicaid, and this is an economic problem because neither of those entities cover people for very long.
"So think about this: we've got a disease where the cost of it manifests long into the future ... 10, 15 years down the road," he said. "But private payers typically are only covering people for about 3 or 4 years. So that creates a significant problem where the payer that has to bear the cost of paying for the treatment doesn't stick around long enough to see the benefits in the future."
Anupam Jena, MD, PhD, outlined the wider public health value of treating HCV. As an infectious disease, curing one person reduces the likelihood of other people getting infected, which changes the way the value of drugs that treat and cure HCV is viewed.
Jena and his colleagues analyzed the impact paying for HCV drugs would have on liver transplants in the United States. There are 2 types of patients with liver disease: those with hepatitis C and those with liver disease from other sources, such as long-standing alcohol abuse, hereditary diseases, and fatty liver disease, which is related to obesity.
“Here’s a really unique example where treating patients with hepatitis C and curing them of the disease actually doesn’t just treat those patients themselves," Jena said. "It has these spillovers to patients with other forms of liver diseases."
Ryan Clary and the National Viral Hepatitis Roundtable, which co-hosted the briefing with the journal, have been working to expand access to treatments and end discriminatory restrictions against people who have HCV.
Unfortunately, most private payers and Medicaid programs have placed restrictions to HCV treatment access almost since the the first treatment was approved by the FDA. Clary outlined some of the practices, which include the requirement that patients have advanced liver disease before they are eligible for treatment.
"A lot of restrictions that you really don't see for any other chronic disease based on substance abuse; sobriety requirements; having to submit urine tests," he said. "Things that you don't have to do for any other chronic disease that I'm aware of."
Addressing the Gap in Mental, Physical Health Care for Caregivers
March 29th 2024The often-overlooked perspective of the caregiver was brought to the forefront of a presentation by Julia Cohen Sebastien at the Greater Philadelphia Business Coalition on Health 2024 Women’s Health Summit.
Read More
Navigating Health Literacy, Social Determinants, and Discrimination in National Health Plans
February 13th 2024On this episode of Managed Care Cast, we're talking with the authors of a study published in the February 2024 issue of The American Journal of Managed Care® about their findings on how health plans can screen for health literacy, social determinants of health, and perceived health care discrimination.
Listen
Risk for Second Primary Melanoma Increases After Primary Melanoma Diagnosis as Men Age
March 28th 2024A population-based cohort study out of Norway has found that older men have a higher risk of developing second primary invasive melanoma following an initial primary melanoma, suggesting the benefits of increased surveillance in these patients.
Read More
Drs Raymond Thertulien, Joseph Mikhael on Racial Disparities in Multiple Myeloma Care Access
December 28th 2023In the wake of the 2023 American Society of Hematology Annual Meeting and Exposition, Raymond Thertulien, MD, PhD, of Novant Health, and Joseph Mikhael, MD, MEd, FRCPC, FACP, chief medical officer of the International Myeloma Foundation, discussed health equity research highlights from the meeting and drivers of racial disparities in multiple myeloma outcomes.
Listen
Poor Well-Being Scores Linked to Early Treatment Stoppage in Multiple Myeloma
March 27th 2024Investigators used the Functional Assessment of Cancer Therapy-General General Physical Wellbeing Scale to collect data on patient-reported treatment-related adverse effects, to provide clinicians guidance on predicting risk of early treatment discontinuation among ECOG-ACRIN E1A11 trial participants.
Read More