HCV Treatment Rate Falls as HCV Detection Declines

HCV Treatment Rate Falls as HCV Detection Declines
By Michael Smith, North American Correspondent, MedPage Today
Published: November 24, 2009
Reviewed by Zalman S. Agus, MD; Emeritus Professor
University of Pennsylvania School of Medicine and
Dorothy Caputo, MA, RN, BC-ADM, CDE, Nurse Planner Earn CME/CE credit
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Even as researchers get a better handle on the disease, treatment rates for hepatitis C appear to be falling, investigators said.

If the trend continues, only 14.5% of liver-related deaths caused by hepatitis C from 2002 to 2030 will be prevented by antiviral treatment, according to Michael Volk, MD, and colleagues at the University of Michigan, Ann Arbor.

The main barrier to treatment, they reported in the December issue of Hepatology, appears to be lack of diagnosis, with only about half of infected people aware of their disease.

"It is concerning that half of all people with hepatitis C in the U.S. are unaware of their diagnosis," Volk said in a statement. "Even with the development of new and better medications on the horizon, such medications will have less than optimal impact unless more patients are diagnosed and referred for treatment."

As of 2001, the researchers said, about 3.2 million Americans were estimated to have hepatitis C. Because many of them were likely to lack health insurance and a consistent source of medical care, the researchers hypothesized that treatment levels would be low.

To find out, they first tried to track the number of prescriptions for peginterferon alpha-2a and alpha-2b (sold as Pegasys and PegIntron, respectively) from 2002 through 2007. The two medications are the standard of care for the disease.

Combing two large databases, they found that 126,000 new retail prescriptions for pegylated interferon were filled in 2002. By 2007, the number had fallen to about 83,000.

Trying to explain the decline, Volk and colleagues turned to the National Health and Nutrition Evaluation Survey (NHANES), which every two years selects a random sample of Americans to participate in a health examination and laboratory testing.

Starting in 2001/2002, participants testing positive for hepatitis C were informed by letter and followed up four months later by telephone.

The NHANES researchers found that 49% of respondents had not known they were infected, and 24% had not been recommended for treatment by their physicians. Only 12% received treatment.

To gauge the long-term effects of these conditions, Volk and colleagues constructed a mathematical population model incorporating the population and prescribing data and asked how current patterns would affect hepatitis C mortality over the period 2002 through 2030.

Without additional treatment, the model showed, the population with chronic hepatitis C would be about 2.97 million in 2030, and the virus would have caused 259,000 liver-related deaths over the intervening years.

With treatment, under current practice patterns, antiviral therapy would prevent 37,500 of those deaths, the researchers said -- or about 14.5% of the total.

The researchers cautioned that the prescribing data came from commercial pharmacies and excluded patients in clinical trials or in Veterans Affairs care. Also, because the NHANES data excludes institutionalized or homeless people, it may underestimate the prevalence of the disease.

On the other hand, they said, the analysis is the first look at nationwide practice patterns for treatment of hepatitis C.

The study was supported by the Greenview Foundation and the American

Gastroenterological Association. The researchers said they had no potential conflicts to report.

Primary source: Hepatology
Source reference:
Volk ML, et al "Public health impact of antiviral therapy for hepatitis C in the United States" Hepatology 2009; DOI: 10.1002/hep.23220.