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