1. HBV and HCV: Americaâs
Hidden Epidemics
Jeffrey Levi, PhD
Trust for Americaâs Health
October 14, 2010
2. Who We Are
ďŻ Trust for Americaâs 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
ďŻ Follow-on to IOM report
ďŻ Concrete strategies for federal action
ďŻ Unique opportunities right now through
Affordable Care Act and scientific
breakthroughs
4. Overview of Problem
ďŻ There are a number of unique challenges that must
be addressed when combating the hepatitis B virus
(HBV) or hepatitis C virus (HCV), including:
ďŽ health complications that take decades to develop;
ďŽ significant social stigmas connected to the viruses;
ďŽ disproportionately impacts racial, ethnic and sexual
minorities; and
ďŽ infectious disease prevention strategies have traditionally
been siloed.
5. Key Findings
ďŻ Nearly two percent of the U.S. population may have
some form of the disease â and approximately five
million of these individuals will develop a chronic
form of the diseases.
ďŻ 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
ďŻ Of the more than five million Americans with HBV
or HCV:
ďŽ Baby Boomers account for two-thirds of HCV cases - and
if left untreated, it could lead to a major increase in
upcoming Medicare spending;
ďŽ African Americans account for 22 percent of HCV cases;
ďŽ Asian and Pacific Islander Americans account for 50
percent of HBV cases; and
ďŽ 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
ďŻ New prevention options and
treatment possibilities due to
Patient Protection and
Affordable Care Act (ACA).
ďŻ Scientific breakthroughs will
make treatment, vaccination
easier.
8. Key Recommendations
ďŻ Tracking hepatitis to better target
prevention and treatment efforts:
ďŽ Build on existing HIV surveillance systems;
strengthen state and local networks
ďŻ Focus on tracking both cumulative cases and
emerging outbreaks
ďŽ Assure that emerging electronic health record
system collects appropriate hepatitis-related data
ďŽ Better tracking of new outbreaks
9. Key Recommendations
ďŻ HBV and HCV screening and HBV
vaccinations should be the standard of care
in the reformed health care system:
ďŽ Screen based on risk factors and age
ďŻ Make this part of initial Medicare visit and essential
health benefit under health reform
ďŻ Reach out to non-traditional settings
ďŽ HBV vaccination should be encouraged as part of
the preventive benefit under health reform and
monitored through electronic health records
10. Key Recommendations
ďŻ Improve treatment by ensuring everyone who is
diagnosed is linked to care and receives the
standard of care:
ďŽ Appropriate coverage and reimbursement for treatment
ďŽ Public-private treatment guidelines updated regularly
ďŽ Plans under Exchanges as well as Medicare and Medicaid
required to meet treatment guidelines and have networks
with qualified providers of hepatitis care
ďŽ Improve referral systems
ďŽ Expand access to wraparound services, perhaps through
Ryan White Program
11. Key Recommendations
ďŻ Assure adherence to treatment:
ďŽ Treatment requires a continuum from point of
screening throughout care
ďŽ Provide appropriate culturally and linguistically
sensitive support services
ďŽ Special consideration for marginalized
populations
12. Key Recommendations
ďŻ Prevent New Infections:
ďŽ Eliminate newborn HBV infections
ďŻ CMS-CDC joint initiative
ďŽ Eliminate health care-associated HBV and HCV
infections
ďŽ Promote universal HBV vaccination
ďŽ Bolster prevention campaigns and public awareness
13. Key Recommendations
ďŻ Strengthen research agenda:
ďŽ Single dose HBV vaccine; develop HCV vaccine;
simplify treatment options; rapid tests
ďŽ Funding proportionate to public health risk
ďŻ NIH funding for hepatitis research is ~$150 million
14. The cost of doing nothing
ďŻ 150,000 Americans could die from liver
cancer or end-state liver disease (IOM)
ďŻ Medical costs for HCV patients could double
over the next 20 years from $30 billion to $80
billion (Milliman)
ďŽ Many of these costs will be borne by Medicare
and Medicaid
ďŽ A comprehensive approach that includes early
diagnosis and treatment can reverse this trend
15. Questions?
ďŻ Please contact:
ďŽ Dara Lieberman, Government Relations Manager
dlieberman@tfah.org, 202-223-9870 x. 20
ďŽ Visit TFAH online at www.healthyamericans.org