Baby boomers face higher mortality from HCV infections

Infections with hepatitis C virus (HCV) will be an important driver of not only higher mortality but also resource utilization among baby boomers, according to a new study.

“Hepatitis C is common in the baby boomer cohort. As baby boomers age, they have a higher number of complications due to HCV infections that lead to hospitalization,” lead author Zabair Younossi, MD, chairman of the Department of Medicine at Inova Fairfax Hospital, told Medical Economics. “We are living in a golden age of hepatitis C. We have effective tests to identify infections, and safe and effective drugs to treat the infections.” 

Younossi and colleagues used data from Medicare databases from 2005-2010 to identify patients with HCV infections and determine resource utilization and short-term mortality. Among the 324,000 hospitalized patients, 13.6% were HCV positive. “The rate of hospitalization for the patients age 65 or higher increased over time. Older patients had higher inpatient charges, more severe illness, and higher mortality in hospital than younger patients,” said Younossi, who is a hepatologist.

The researchers published the results in the May 2016 Alimentary Pharmacology & Therapeutics. 

“Medicare will have to cover these patients in years to come. The economic impact of HCV will increase if we don’t do something now. Hospital inpatient resources are going to increase for HCV, regardless of the payer. It’s important to apply available, very effective treatments to prevent these complications in the future.”

The use of direct-acting anti-viral agents (DAAs) can reduce mortality and resource utilization, and lead to long-term financial benefits, he said. “A number of DAAs are available, and new ones are coming to market. These drugs cure 98% of patients, and are well tolerated. Most patients have few side effects,” said Younossi.

Drug cost is still an issue, but competition has driven the cost down. “Even at $100,000 a year, these drugs are cost-effective from a societal perspective. They reduce the cost of HCV-related complications in the future, including hospitalization and early mortality,” he said.

The issue is how to use the drugs now. “I think every HCV-positive patient should be treated regardless of disease severity or age,” said Younossi. “Certainly, patients with more advanced liver disease and extrahepatic manifestations should be prioritized to treatment.”

Younossi calls for a five-year plan to eradicate HCV in the U.S. “HCV can be cured. We need a reasonable plan of resources to determine how many hepatologists or GI specialists are needed. Primary care physicians play a role in identifying patients and screening baby boomers who meet the criteria for HCV, and then properly treating them or referring them to a specialist,” he said.

“Someone will own the cost of these patients in the future when they are more difficult to manage,” Younossi continued. “In general, that will be the U.S. government through Medicare and Medicaid programs. We need to get all stakeholders together—patients, providers and the government—to do something about this now to prevent a tsunami of HCV infections.”