New breakthrough medicines for Hepatitis C present an important choice about setting goals and taking systemic action to achieve public health advances in the United States. Despite appearing to offer cure rates greater than 90 percent, high-priced Hepatitis C drugs have driven treatment rationing since their approval over two years ago. Gaps in the screening, diagnosis, and treatment of Hepatitis C pose significant public health consequences.
In May, the Centers for Disease Control and Prevention (CDC) identified Hepatitis C as the leading infectious killer in the United States in 2014-the first year in which new medicines for the disease were available-claiming more lives (nearly 20,000) than 60 other infectious diseases, including HIV/AIDS, pneumococcal disease, and tuberculosis, combined.
However, recent steps have improved the prospects for many patients waiting for treatment. In March, the Veterans Affairs department announced access to Hepatitis C medicines for all patients regardless of disease stage. Last month, New York State Medicaid also lifted treatment restrictions. A newly organized Institute of Medicine committee on viral hepatitis proclaimed in its interim April report that the “elimination of hepatitis C as a public health problem in the United States is feasible.” Notably, the committee stopped short of setting a national goal for the elimination of Hepatitis C, as they continue to study the challenge for their final report due in 2017.
While advances in access to Hepatitis C treatment for some individuals could mark an important shift, we suggest that increased access can be leveraged in the direction of a larger, strategic aim: an explicit public health target.
Target: A ‘Rare Disease’ By 2025
Multiple indicators could be used to define such a target for Hepatitis C, such as deaths averted, percent treated and/or cured, incidence, or population prevalence. We demonstrate one possible approach, using a model published last November in Health Affairs by Van Nuys and colleagues. With a baseline scenario of using older interferon-based therapies, the model considered three treatment scenarios for Hepatitis C with the newest medicines: treat patients with advanced disease, treat all diagnosed patients regardless of disease stage, or treat 5 percent of diagnosed patients across all disease stages. They found that the option of treating 5 percent of the infected population annually would best balance potential benefits with affordability.