—Lucinda K. Porter, RN
Changing Epidemiology of Hepatitis C Virus Infection in the United
States: National Health and Nutrition Examination Survey 2001 through
2010 – Ivo Ditah, et al.
Source: Journal of Hepatology Accepted manuscript November 2013
Nutrition Examination survey (NHANES) collects hepatitis C virus (HCV)
data in the U.S. civilian population. The goal of this study was to
assess the current burden of HCV. More than 52,000 participated; 38,000
were tested for HCV.
HCV-antibody prevalence from 1.9% in 2001 to 1.3% in 2005, remaining
stable through 2010. About 67% of these were positive for HCV RNA,
which was extrapolated to 2.3 million people with chronic HCV
infection; 70% of HCV infections occur in those born between 1945 and
infection in the US is at its lowest since the 1990s. HCV-antibody
prevalence among those under age 30 is approximately 17,000 new
infections annually. This survey confirms other recent studies showing
that risk of HCV transmission among non-HIV infected heterosexual
partners is almost nonexistent, regardless of the number of lifetime
sexual partners. Sexual transmission of HCV is a significant risk among
HIV-infected men who have sex with men.
The biggest risk factors for HCV are being between ages 45 and 65,
born in the USA, having less than high school education, lifetime drug
use, abnormal alanine aminotransferase (ALT) levels, and
having antibodies to herpes simplex virus type 2.
The statement that stands out for me in this paper is, “This
prevalence is almost certainly an underestimate as NHANES does not
include some high risk populations, including the incarcerated,
hemodialysis patients and the homeless.” Since NHANES collects data
from the non-institutionalized, civilian U.S. population, the numbers
have long been called into question. Other experts feel the numbers are
significantly higher, a possibility this paper acknowledges.
Source: Journal of Hepatology December 2013
associated with reduced quality of life in hepatitis C patients. The
goal of this study was to assess health-related quality of life in
patients using interferon-free hepatitis C treatments. Comparisons were
made in the following:
- patients taking sofosbuvir and ribavirin versus placebo
- patients taking sofosbuvir and ribavirin with and without pegylated interferon
decreased in all treatment arms. Scores were similar between sofosbuvir
and ribavirin versus placebo. However, patients taking pegylated
interferon had significantly reduced quality of life. Longer durations
of treatment with sofosbuvir and ribavirin did not further reduce
quality of life. Patients taking sofosbuvir and ribavirin who had a
sustained virologic response at 12 weeks (SVR-12) had improved
health-related quality of life.
Patients taking sofosbuvir and ribavirin reported mild reductions in
health-related quality of life, but appeared to be improved after
achieving an SVR-12.
Hepatitis C patients have waited a long time for interferon-free
treatment. With the approval of Sovaldi (sofosbuvir), the wait is over
for patients with genotypes 2, 3, and other sub groups. Patients are
wondering if they should start treatment now or wait for ribavirin-free
choices. This study may help them make that choice.
Minimum Costs for Producing Hepatitis C Direct Acting Antivirals, for
Use in Large-Scale Treatment Access Programs in Developing Countries –
Andrew Hill, et al.
Source: Clinical Infectious Diseases Advance Access published January 6, 2014
manufacturing costs for 12-week courses of various hepatitis C drugs.
Here are the findings in U.S. dollars:
- $68 – $136 for sofosbuvir (Sovaldi)
- $130 – $270 for simeprevir (Olysio)
- $21- $63 for ribavirin
- $10 – $30 for daclatasvir (not FDA-approved yet)
- $100 – $210 for faldaprevir (not FDA-approved yet)
cost of research and development drives up the cost of drugs, but so
does profit. This analysis seems so optimistic when compared to the
Wholesale Acquisition Costs of sofosbuvir (Sovaldi) at $84,000 and
simeprevir (Olysio) at $66,360. Although I hope that profit does not
interfere with the very real chance that hepatitis C could be
eradicated, I alternate between being skeptical and cautiously
Source: Milliman Report commissioned by Janssen Therapeutics December 2014
healthcare, and this report explores the impact of hepatitis C virus
(HCV) on public health and policy. The Milliman Report authors use the
term “the great convergence” to describe factors that are coming
- CDC recommendations endorsed by the USPSTF to
screen the U.S. Baby Boomers, those born 1946 to 1964. This screening
is a covered service that must be provided at no cost to those who have
- The “baby boomer” population is entering into Medicare.
- These factors mean that more people will become aware of their HCV status.
- Because of ACA, the number of those with health insurance is expanding, thus more people will have access to HCV treatment.
- New HCV treatments are in development, opening up more opportunities for patients.
In deference to the following statement, “Because extracts of this
report taken in isolation may be incomplete or misleading, we ask that
this report be distributed only in its entirety,” a link to the entire
report is provided rather than a bottom line: http://us.milliman.com/insight/2013/Healthcare-reform-and-Hepatitis-C-A-convergence-of-risk-and-opportunity/
Editorial Comment: My 2009 copy of the Milliman Report, Consequences of Hepatitis C Virus (HCV) is dog-eared from use. This current report is not as compelling, but contains good graphics and information.Share This Page