The continuum of care is failing many hepatitis C patients who do not complete recommended care and treatment protocols.
- Hepatitis C patients often drop off the radar of healthcare organizations along the continuum of care before receiving adequate treatment for the viral liver disease, finds a new study published in Hepatology. Despite the prevalence of the condition, and the potential for the infection to lead to severe liver damage and the need for transplants, up to three-quarters of patients who are HCV positive are unaware of the infection, and fewer than 20% ever receive treatment.
“The inadequacy of screening programs has made it difficult for state health departments to accurately determine the extent of HCV and the rate of transmission within the community,” explains Kendra Viner, PhD, MPH, from the Philadelphia Department of Public Health. “Our study examines the management of HCV care at a population level to determine which patients tend to fall out of the medical system and why this might occur.”
Viner used public health surveillance data from the Philadelphia area from 2010 to 2013 to examine the prevalence of HCV in the region, and found 13,596 individuals with positive test results during the study time period, while 6383 had positive HCV-RNA tests. Only 956, or 15 percent, of those patients had been treated or were receiving treatment for the virus. “Our findings show that many HCV patients are lost at each stage of the health care continuum from screening to disease confirmation to care and treatment,” Viner said.
Researchers have been working steadily over the past quarter-century on treatments and cures for the disease, and have successfully raised the potential cure rate from 6% to more than 90% today, according to a recent report from the Pharmaceutical Research and Manufacturers of America (PhRMA). However, one of the most effective breakthrough treatments for HCV is also the most expensive, with a price tag that has caused a great deal of debate among healthcare providers.
The 95% effective therapy, called Sovaldi, costs $1000 per day and has an 8% non-adherence rate over the 12 weeks of therapy required to cure the viral infection. “While the drug is extremely effective and may offer value in terms of reducing downstream costs, the short-term monetary outlays are considerable and were largely unexpected,” says a study on patient behaviors examining the impact of the drug. “The costs have led to an outcry from payors and policymakers, and resulted in widespread debates about the ‘fairness’ of the medication’s pricing.”
The non-adherence problem is even more concerning due to the high number of HCV patients who don’t even make it to that stage of their treatment. “The fact that so few patients with HCV are making it to treatment underscores the need to build awareness among at-risk groups of the importance of screening and continued care,” Viner says. “It is critical that public health officials and clinicians understand why patients are lost at each stage so that changes can be made to improve care for those with chronic HCV.”