Tuesday, November 5, 2024
Subscribe American Journal of Medicine Free Newsletter
health careIn a Critical State: Ongoing Barriers to Treatment for Hepatitis C Virus...

In a Critical State: Ongoing Barriers to Treatment for Hepatitis C Virus (HCV)


5
Recent advances in hepatitis C virus (HCV) treatment could be described as revolutionary: for uncomplicated patients, treatment is nearly 100% effective, oral only, has a low pill burden, minimal side effects, and results in a cure.1 Comparisons we have heard from clinicians are that HCV is now easier to treat than either diabetes or hypertension. Unfortunately for many patients, their state of residence is the decisive factor for whether they will receive lifesaving treatment. As part of a tribal telehealth network for HCV, we support several rural clinics successfully treating HCV and see this dilemma all too frequently.

Consider a patient with chronic HCV infection who presents with a recent history of marijuana use and has been late picking up hypertension medication. The patient has cirrhosis and is at high risk of HCV-related mortality. He is enrolled in state Medicaid and highly motivated for treatment. What is the treatment plan? It depends on the state. A resident of New Mexico can start treatment without delay. If instead the patient lives in Montana, a state that determines treatment eligibility based on advanced liver fibrosis, documented sobriety, and compliance with existing medications, the consultation is effectively moot; treatment will be denied. Montana is far from alone in its HCV treatment restrictions. Patients in South Dakota, Nebraska, and several other states we serve face similar hurdles (see Figure).2, 3, 4

 

These delays matter because prompt treatment saves lives. The number of deaths from HCV outnumber those caused by human immunodeficiency virus, tuberculosis, and pneumococcal disease combined.5 Successful treatment of HCV has been documented to reduce liver failure by 90%, liver cancer by 70%, and all-cause mortality by 50%.6, 7, 8 Patients with HCV-related cirrhosis who are cured can have a full life expectancy.9

In spite of the clinical importance of treatment, a recent study inclusive of 45 states found that about one-third of persons with HCV were denied treatment by public or private insurance.10 Patients with private insurers fared even worse than Medicaid; in the same study, over 50% were denied treatment. The paradox for patients residing in states with restrictive treatment criteria is that the intended safety net of public insurance leads instead to long delays that end in denials, and the surest route to treatment is to have no insurance and be ineligible for Medicaid, a profile that qualifies for drug assistance from manufacturers.

To read this article in its entirety please visit our website.

-Jorge Mera, MDa, Brigg Reilley, MPHb,, Jessica Leston, MPHb, David Stephens, RNb

This article originally appeared in the May 2019 issue of The American Journal of Medicine.

Latest Posts

lupus

Sarcoidosis with Lupus Pernio in an Afro-Caribbean Man

A 54-year-old man of Afro-Caribbean ancestry presented with a 2-month history of nonproductive cough, 10-day history of constant subjective fevers, and a 1-day history...
Flue Vaccine

Flu Vaccination to Prevent Cardiovascular Mortality (video)

0
"Influenza can cause a significant burden on patients with coronary artery disease," write Barbetta et al in The American Journal of Medicine. For this...
varicella zoster

Varicella Zoster Virus-Induced Complete Heart Block

0
Complete heart block is usually caused by chronic myocardial ischemia and fibrosis but can also be induced by bacterial and viral infections. The varicella...
Racial justice in healthcare

Teaching Anti-Racism in the Clinical Environment

0
"Teaching Anti-Racism in the Clinical Environment: The Five-Minute Moment for Racial Justice in Healthcare" was originally published in the April 2023 issue of The...
Invisible hand of the market

The ‘Invisible Hand’ Doesn’t Work for Prescription Drugs

0
Pharmaceutical innovation has been responsible for many “miracles of modern medicine.” Reliance on the “invisible hand” of Adam Smith to allocate resources in the...
Joseph S. Alpert, MD

New Coronary Heart Disease Risk Factors

0
"New Coronary Heart Disease Risk Factors" by AJM Editor-in Chief Joseph S. Alpert, MD was originally published in the April 2023 issue of The...
Cardiovascular risk from noncardiac activities

Cardiac Risk Related to Noncardiac & Nonsurgical Activities

0
"Assessment of Cardiovascular Risk for Noncardiac and Nonsurgical Activities" was originally published in the April 2023 issue of The American Journal of Medicine. Cardiovascular risk...