HBV and HCV: America’s Hidden Epidemics

1. HBV and HCV: America’s Hidden Epidemics Jeffrey Levi, PhD Trust for America’s Health October 14, 2010

2. 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.

3. 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

4. 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.

5. 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.

6. 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.

7. 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.

8. 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

9. 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

10. 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

11. 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

12. 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

13. 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

14. 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

15. Questions? • Please contact: • Dara Lieberman, Government Relations Manager dlieberman@tfah.org, 202-223-9870 x. 20 • Visit TFAH online at www.healthyamericans.org