CHI Report – Innovation in Hepatitis C Treatment – Page – 5
The Public-Health Response to Hepatitis C
Despite the high prevalence and mortality rates of hep C in the US, the public response to the disease has been muted, especially compared with the national commitment to tackling other serious public health crises such as HIV/AIDS. For example, an analysis published in 2011 in the journal Nature noted that the CDC spent $728 million in 2010 on prevention and surveillance activities against HIV/AIDS versus $9 million against hep C. xv Similarly, the US Health Resources and Services Administration7 reported spending $2.3 billion on HIV care and treatment and $70 million on hep C (Exhibit 3).
The contrast between HIV and hep C becomes particularly compelling when one considers the impact that these disproportionate public-health responses have had on the epidemiology of the diseases. In the past two decades, scientific research and innovation coupled with the public commitment to the fight against HIV/AIDS have brought the HIV-related mortality rate down to very low levels. 8 In contrast, the hep C mortality rate has risen continuously and in 2007 actually surpassed that of HIV (Exhibit 3). xvi Because HCV is often a contributing factor to a variety of disorders, a report published by CDC-affiliated authors recently estimated that more than two-thirds of hep C-related deaths are not reported as such, meaning that the mortality rate should, in fact, be significantly higher.ii This comparison offers a glimpse into the magnitude of the public and private investment that was necessary to effectively tackle the HIV epidemic; a similar response to hep C might be not only warranted but overdue. It is worth noting that co-infection among HIV and hep C patients is substantial (25 percent of HIV patients are also hep C-positive xvii ); hence, responses to the two diseases will need to be coordinated closely.
The Challenge of Treating Hep C
Historically, the fight against hep C has been hampered in the US by four interconnected and mutually reinforcing factors: 1) Medicines with low cure rates and significant side effect profiles, 2) low diagnosis rates that leave perhaps 2 million hep C-infected people unaware of their status, 3) low treatment rates even among those aware of their status, and 4) socio-economic forces limiting access to health care for patient populations especially vulnerable to hep C.
In this report, we examine in detail the remarkable progress in addressing the first factor (imperfect medicines) and explore the impact that breakthrough innovation is having and will continue to have on the hep C epidemic in the US. We briefly touch upon the second (low diagnosis rates) and third (low treatment rates) factors, recognizing that designing the optimal public-health strategy to tackle hep C by targeting the right treatment to the right patients is a complex endeavor beyond the scope of this report.
6 Estimated US average 2011 billed charges per transplant
7 The HRSA is a federal agency that provides supplemental funding to health care providers that care for uninsured patients and other vulnerable groups.