Public health impact of antiviral therapy for hepatitis C in the United States

What is needed: (1) funding for screening/testing (comprehensive programs, (2) linkages to care programs, (3) comprehensive support services for patients & clinicians

Public health impact of antiviral therapy for hepatitis C in the United States - 50% Undiagnosed- (10/20/09)
Hepatology Early View Oct 2009

"future development of new and better medications will have a less than optimal impact on this problem unless more patients are diagnosed and referred for treatment. Increased public health efforts are needed to improve access to antiviral therapy for patients with hepatitis C."....."Approximately 663,000 patients received antiviral therapy between 2002 and 2007, and treatment rates appear to be declining"...... "Only by increasing treatment rates by 75% and increasing SVR rates to 75% could more than half of the liver-related deaths be prevented."< /font>....."primary reason for lack of treatment is lack of diagnosis......49%, were previously unaware of their diagnosis......24% were recommended by their doctor not to be treated"

"respondents lacking a usual source of medical care were 19 times more likely to be unaware of their diagnosis"....."Because the U.S. Preventative Services Task Force has concluded that insufficient evidence exists to recommend screening for hepatitis C, physicians may consider this a low priority. physicians may not realize the value of diagnosing hepatitis C, because prior studies have identified limited knowledge about the disease among pri mary care physicians.[14] Thus, increasing the number of patients diagnosed will require education of the public and physicians alike, as well as attention to the worsening problem of the uninsured in the U.S.....some patients may not follow up for further care, and others may not be referred to a specialist who prescribes antiviral therapy......patients in some areas may have limited access to specialists who treat hepatitis C, because 20% of all gastroenterologists prescribe 80% of antiviral therapy in this country........it is possible that future improvements in antiviral therapy will increase enthusiasm for treatment among the medical community, and thus increase the number of patients treated. However, very little is known about health services delivery and quality of care for hepatitis C, and further research in this area is needed."

"In this study we estimated the number of patients currently receiving antiviral therapy for hepati tis C in the U.S., identified reasons for lack of treatment, and pro jected the impact current therapy will have on preventing liver-related deaths over the next two decades. We found that relatively few patients have been treated with pegylated interferon, and treatment rates appear to be declining. These findings are similar to a recent report from Europe, in which treatment rates varied by country from <1% to 16% of hepatitis C patients ever treated.[27] If this trend continues, antiviral therapy may prevent fewer than 15% of liver-related deaths caused by hepatitis C in the U.S. between 2002 and 2030."

"Fortunately, new treatments for hepatitis C are anticipated to become available in the next several years, which should increase rates of SVR among patients receiving treatment.[28] However, treatment first requires a diagnosis, and in this study we found that approximately half of all people with hepatitis C in the U.S. are unaware of their diagno sis."

"There would be 259,000 liver-related deaths caused by hepatitis C between 2002 and 2030 without treatment, and current antiviral therapy would prevent 37,500 of these. Thus, the current state of antiviral therapy is projected to prevent only 14.5% of liver-related deaths caused by hepatitis C between 2002 and 2030.....Approximately 663,000 patients received antiviral therapy between 2002 and 2007, and treatment rates appear to be declining.....If the discovery of new medications in the future increases rates of SVR to 75%, at current rates of treatment this would still only prevent 21.7% of liver-related deaths caused by hepatitis C. Only by increasing treatment rates by 75% and increasing SVR rates to 75% could more than half of the liver-related deaths be prevented......primary reason for lack of treatment is lack of diagnosis......49%, were previously unaware of their diagnosis..... .9% did not follow up with a doctor about their hepatitis C......24% were recommended by their doctor not to be treated......6% refused treatment.....12% were treated......28% of the 100 subjects who had seen a doctor by the time of the survey had the understanding that no further follow-up for their hepatitis C was necessary"