CHI Report – Innovation in Hepatitis C Treatment – Page – 4
The Impact of Hepatitis C
Hep C progresses slowly but can be fatal. The CDC estimates that for every 100 patients infected with HCV, 65 will develop chronic liver disease, 13 will develop cirrhosis, and 3 will die as a consequence of their infection (Exhibit 2). xi Academic studies have suggested much higher mortality rates, including one source that estimates that up to 30 percent of chronically infected patients will die a hep C-related death. xii In terms of absolute numbers, a report published by CDC-affiliated authors notes that 16,622 hep C-related deaths were recorded in 2010; however, after taking into account the underdiagnosis of the disease and inadequate record-keeping, they estimated that hep C-related mortality may be closer to 53,000 people annually in the US. ii
5 Defined here as two times the poverty threshold
In addition to devastating mortality, hep C causes significant morbidity. Chronic liver disease and cirrhosis can lead to jaundice, anemia, type 2 diabetes, brain toxicity, and liver cancer. Importantly, if treatment is delayed until later in the disease progression, many of these debilitating symptoms persist even after a patient is cleared of the HCV infection, because the liver has already been permanently damaged. The disease is currently the nation’s leading cause of liver cancer. It is also the leading cause of liver transplants in the US; in many instances, liver transplant is the only treatment option for advanced cirrhosis or liver cancer. Unfortunately, the supply of livers available for transplant is inadequate, with more than 16,000 people in the US currently on slow-moving transplant waiting lists. xiii
Finally, hep C has considerable economic costs, largely because of its high prevalence in the US. A 2013 study estimated that US commercial payers spend five times as much on hep C-positive patients as they do on their average members.x Partly due to the defects of earlier drug regimens, in the past, only 20 percent of the money spent for the care of hep C patients paid for prescription drugs; the rest went to inpatient and outpatient facility costs and professional fees associated not only with direct hep C care but also with related conditions and sicknesses.x Treatment for late stage complications of hep C can be quite expensive; for example, the estimated cost of a liver transplant is $577,000. xiv In the future, the introduction of new drug regimens into the market and the coverage expansion under the ACA are expected to cause substantial shifts in the economics of hep C treatment.