The deal New York needs to eliminate hepatitis C

What if I told you that there are now over 200,000 people infected with the hepatitis C virus in our state, and that these numbers—especially among young New Yorkers—are growing, fueled in large part by the opioid epidemic? What if I explained...

The deal New York needs to eliminate hepatitis C

What if I told you that there are now over 200,000 people infected with the hepatitis C virus in our state, and that these numbers—especially among young New Yorkers—are growing, fueled in large part by the opioid epidemic? What if I explained...

15 mart 2017 Wednesday 18:40
2425 Reads
The deal New York needs to eliminate hepatitis C

What if I told you that there are now over 200,000 people infected with the hepatitis C virus in our state, and that these numbers—especially among young New Yorkers—are growing, fueled in large part by the opioid epidemic? What if I explained that hepatitis C causes liver disease that can progress over time to death, and that liver cancer is one of the fastest-growing cancers in the U.S., largely driven by hepatitis C? Not only are lives lost, but the cost of caring for someone with liver cancer is over $100,000 a year, and a transplant can cost $500,000 or more.

Now, what if I told you that it is entirely possible to eliminate hepatitis C altogether?

Last week, a group of 119 health care and community-based organizations, including Housing Works, sent a consensus statement on Hep C elimination to Gov. Andrew Cuomo, Assembly Speaker Carl Heastie and Senate Majority Leader John Flanagan. It called on the them and industry partners to make a joint commitment to the statewide elimination of hepatitis C, and requested the appointment of a state task force to accomplish it. It is completely within our ability to end hepatitis C, and now is the time for action.

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Unlike HIV, which requires lifelong medication to keep the virus in check, we have a cure for hepatitis C. Treatment involves taking one or more pills per day for four to 12 weeks, and has very few side effects and a 95% cure rate. Previous options required six months of treatment, came with often-intolerable side effects, and were only effective 50% of the time. Given the effectiveness and ability to tolerate current treatment, we can now seriously call for eliminating hepatitis C in New York by treating as many patients as possible to curb new transmissions.

There are barriers to achieving this goal, but none are insurmountable with adequate political will. Only half of people living with hepatitis C in the state know that they are infected. We can change this through public and health provider education, strengthening our testing law, routine testing in clinical settings and increased targeted testing in drug-treatment programs, syringe programs and other places likely to serve people who are infected. We can build a robust hepatitis C treatment infrastructure in New York state to care for all those previously and newly diagnosed. Repurposing the very successful HIV treatment infrastructure and expanding hepatitis C treatment capacity within primary care, licensed drug treatments programs and corrections facilities, can make them hubs of treatment and cures. Indeed, what we have learned from HIV is that we can successfully maintain almost anyone on treatment, given the right support.

The remaining barrier is a payment model that enables the broadest patient access to high-value cures while mitigating budget impact. Much has been made of the cost of each individual treatment. We have new evidence that the cost of treatment has decreased significantly since Gilead brought the first of these new cures to market at $84,000 per treatment course. Several other manufacturers have introduced competing drugs, causing prices to decrease dramatically. We understand that Medicaid departments across the county that have opened access to treatment pay approximately $20,000 to $30,000 per course of treatment, a price that is significantly less than initial list prices. At these prices, hepatitis C treatments have been shown to be cost-effective and even cost-saving to the health care system. However, the state operates in an annual budget cycle, causing a disconnect between the immediate cost of a cure and the savings accrued over a longer period.

The greatest value to the state will be in treating a high volume of patients and eliminating this infectious disease as quickly as possible. Manufacturers and government must find a solution for cures that addresses the inherent budgetary strain of treating a high volume of patients. Advocates are calling for a new type of deal, one that amortizes the cost of curing hepatitis C for the entire Medicaid population. Manufacturers and the state should negotiate a deal that amortizes the cost of cure for the total Medicaid population infected with hepatitis C, and perhaps the infected population in correctional institutions as well, over an extended period of time. For example, assuming there are around 100,000 people on Medicaid in need of treatment, New York state could commit to paying the cost of 10,000 cures per year over a decade. Providers would be free to treat as many people as possible but New York state would only pay for 10,000 courses of medication each year. The more people we can treat and cure upfront, the greater the cost savings and public health benefit.

Such an arrangement will require creativity on the part of both manufacturers and the state. It would probably also require federal Centers for Medicare and Medicaid Services approval. But it would be well worth the effort. It would allow us to cure a majority of all people infected in New York, thus allowing us to put a brake on new infections. And it would provide a new model of partnership between drug manufacturers and payers. This is the deal we need to eliminate hepatitis C statewide.

Charles King is president and CEO of Housing Works, a nonprofit organization fighting homelessness and AIDS.

What if I told you that there are now over 200,000 people infected with the hepatitis C virus in our state, and that these numbers—especially among young New Yorkers—are growing, fueled in large part by the opioid epidemic? What if I explained that hepatitis C causes liver disease that can progress over time to death, and that liver cancer is one of the fastest-growing cancers in the U.S., largely driven by hepatitis C? Not only are lives lost, but the cost of caring for someone with liver cancer is over $100,000 a year, and a transplant can cost $500,000 or more.

Now, what if I told you that it is entirely possible to eliminate hepatitis C altogether?

Last week, a group of 119 health care and community-based organizations, including Housing Works, sent a consensus statement on Hep C elimination to Gov. Andrew Cuomo, Assembly Speaker Carl Heastie and Senate Majority Leader John Flanagan. It called on the them and industry partners to make a joint commitment to the statewide elimination of hepatitis C, and requested the appointment of a state task force to accomplish it. It is completely within our ability to end hepatitis C, and now is the time for action.

Unlike HIV, which requires lifelong medication to keep the virus in check, we have a cure for hepatitis C. Treatment involves taking one or more pills per day for four to 12 weeks, and has very few side effects and a 95% cure rate. Previous options required six months of treatment, came with often-intolerable side effects, and were only effective 50% of the time. Given the effectiveness and ability to tolerate current treatment, we can now seriously call for eliminating hepatitis C in New York by treating as many patients as possible to curb new transmissions.

There are barriers to achieving this goal, but none are insurmountable with adequate political will. Only half of people living with hepatitis C in the state know that they are infected. We can change this through public and health provider education, strengthening our testing law, routine testing in clinical settings and increased targeted testing in drug-treatment programs, syringe programs and other places likely to serve people who are infected. We can build a robust hepatitis C treatment infrastructure in New York state to care for all those previously and newly diagnosed. Repurposing the very successful HIV treatment infrastructure and expanding hepatitis C treatment capacity within primary care, licensed drug treatments programs and corrections facilities, can make them hubs of treatment and cures. Indeed, what we have learned from HIV is that we can successfully maintain almost anyone on treatment, given the right support.

The remaining barrier is a payment model that enables the broadest patient access to high-value cures while mitigating budget impact. Much has been made of the cost of each individual treatment. We have new evidence that the cost of treatment has decreased significantly since Gilead brought the first of these new cures to market at $84,000 per treatment course. Several other manufacturers have introduced competing drugs, causing prices to decrease dramatically. We understand that Medicaid departments across the county that have opened access to treatment pay approximately $20,000 to $30,000 per course of treatment, a price that is significantly less than initial list prices. At these prices, hepatitis C treatments have been shown to be cost-effective and even cost-saving to the health care system. However, the state operates in an annual budget cycle, causing a disconnect between the immediate cost of a cure and the savings accrued over a longer period.

The greatest value to the state will be in treating a high volume of patients and eliminating this infectious disease as quickly as possible. Manufacturers and government must find a solution for cures that addresses the inherent budgetary strain of treating a high volume of patients. Advocates are calling for a new type of deal, one that amortizes the cost of curing hepatitis C for the entire Medicaid population. Manufacturers and the state should negotiate a deal that amortizes the cost of cure for the total Medicaid population infected with hepatitis C, and perhaps the infected population in correctional institutions as well, over an extended period of time. For example, assuming there are around 100,000 people on Medicaid in need of treatment, New York state could commit to paying the cost of 10,000 cures per year over a decade. Providers would be free to treat as many people as possible but New York state would only pay for 10,000 courses of medication each year. The more people we can treat and cure upfront, the greater the cost savings and public health benefit.

Such an arrangement will require creativity on the part of both manufacturers and the state. It would probably also require federal Centers for Medicare and Medicaid Services approval. But it would be well worth the effort. It would allow us to cure a majority of all people infected in New York, thus allowing us to put a brake on new infections. And it would provide a new model of partnership between drug manufacturers and payers. This is the deal we need to eliminate hepatitis C statewide.

Charles King is president and CEO of Housing Works, a nonprofit organization fighting homelessness and AIDS.

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