A report from the National Academies of Sciences, Engineering, and Medicine proposes a strategy to eliminate hepatitis B and C as serious U.S. public health problems and prevent nearly 90,000 deaths by 2030.
"Viral hepatitis is simply not a sufficient priority in the United States," said Brian Strom, MD, MPH, chair of the committee that carried out the study and chancellor and university professor at Rutgers Biomedical and Sciences of Rutgers University. "Despite being the seventh leading cause of death in the world—and killing more people every year than HIV, road traffic accidents, or diabetes—viral hepatitis accounts for less than 1% of the National Institutes of Health research budget."
About 1.3 million people in the U.S. have chronic hepatitis B, and about 2.7 million have chronic hepatitis C. These infections also increase risk of liver cancer. Together, hepatitis B and C cause about 80% of the cases worldwide of liver cancer, which has been increasing steadily in the U.S. since the early 2000s.
Hepatitis B is preventable with vaccination, and recent advances in treatment make hepatitis C curable with short and easily tolerable courses of medicines. The committee said the number of deaths from hepatitis B could be halved by 2030 by diagnosing 90% of the nation's chronic hepatitis B patients, bringing 90% of those to care, and treating 80% of those for whom treatment is warranted. These actions would avert more than 60,000 deaths.
Similarly, treating everyone with chronic hepatitis C would reduce new infections by 90% by 2030 and reduce hepatitis C deaths by 65% over that time, averting 28,800 deaths. This would depend on diagnosing 110,000 new cases a year between now and 2020, gradually dropping off to 70,000 a year by 2025.
The committee said eliminating hepatitis B and C will require a significant departure from the status quo—including aggressive testing, diagnosis, treatment, and prevention methods, such as needle exchange. It called for a coordinated federal effort to manage hepatitis elimination, and it recommended expanding syringe exchange for people who inject drugs, free hepatitis B vaccine in pharmacies and other easily accessible places, and unrestricted treatment for everyone with hepatitis C.
Because the medicines that cure chronic hepatitis C are expensive, the committee gave considerable attention to novel ways to pay for them and recommended a voluntary licensing agreement between the federal government and a patent-holding pharmaceutical company as a way to make the drug more affordable for Medicaid beneficiaries and other underserved patient populations.
The committee's calculations suggested a patent license should cost about $2 billion, after which states and the federal government would pay about $140 million to produce the medicines needed to treat about 700,000 neglected patients. For comparison, under the status quo, it would cost about $10 billion over the next 12 years to treat only 240,000 of the same people.
Source: National Academies of Sciences, Engineering, and Medicine; March 28, 2017.