Elimination of hepatitis B and C now feasible

Hepatitis B and C can be eliminated as a public health problem, according to a new report from the National Academies of Sciences, Engineering, and Medicine.

“This is feasible because new technologies have been developed, in particular an effective hepatitis B vaccine and direct-acting antivirals (DAAs) for hepatitis C, which are basically curative,” Brian Strom, MD, chancellor for Rutgers Biomedical and Health Sciences at Rutgers, The State University of New Jersey, told Medical Economics.

Strom chaired the Committee for a National Strategy for the Elimination of Hepatitis B and C that produced the report, "Eliminating the Public Health Problem of Hepatitis B and C in the United States: Phase One Report."

This report is phase one to define the primary barriers to solving the problem. Phase two of the report, due out next year, will address how to address those barriers, Strom said.

The report notes that hepatitis B and C account for more than 1 million deaths worldwide, 78% of the world's hepatocellular carcinoma, and more than half of all fatal cirrhosis every year. In 2013, hepatitis B and C virus surpassed HIV and AIDS to become the seventh leading cause of death in the world.

Both diseases can be eliminated as a public health problem, the report states, but “this would take considerable will and resources; disease control may be more manageable in the short-term.”

“These two diseases cause about 80% of liver cancer. If we cure the diseases, we cure liver cancer, which is both fatal and expensive,” Strom said. “Part of the cost-effectiveness of the drugs is they can help prevent cancer. Yet, society hasn’t put enough emphasis or focus on this.”

He believes that DAAs are cost-effective even though they are costly. “Insurance companies have put restrictions in place on DAAs because of costs. As more of these drugs come out, prices should come down. Even at present costs, they are cost-effective to society from the long-term point of view. But insurance companies only look at this year’s cost, not the cumulative cost, of care,” Strom said.

Often, people infected with hepatitis are asymptomatic and don’t become diagnosed until later disease stages when the damage has already been done. “We want to intervene early and prevent transmission person-to-person before people become symptomatic,” said Strom, noting that this will require a reinforced national surveillance system.

Surveillance is important for immigrants, particularly for those from Asia and Africa, who may be harboring hepatitis B infections. “We can screen people for hepatitis, and once they are found to be positive, they need treatment. But detection doesn’t help if they don’t have the insurance to get treatment,” he said.

Strom noted that only about 2% of hepatitis C patients are treated, and only a small percentage of baby boomers get tested for the infection.

“As physicians, we need to take responsibility for society to be more concerned about hepatitis. We can do something now, which wasn’t the case 10 years ago,” Strom said.