Research presented this week at The Liver Meeting® — held by the American Association for the Study of Liver Diseases — suggests the United States Veteran Healthcare Administration could potentially cure almost all U.S. veterans in its care who have hepatitis C (HCV) within two-to-three years.
The availability of direct-acting antiviral agents (DAAs) in the treatment of viral hepatitis, coupled with increased funding for these treatments, has led to a 14-fold increase in the number of veterans cured of hepatitis C annually. Although DAAs for HCV are effective, the use of these medications may be limited due to cost and access to care.
Researchers recently looked at the introduction DAAs, and the availability of funding for them, to determine the impact those two things have on the ability to treat and cure veterans with HCV.
“We now have well-tolerated, safe and effective medications that can eradicate hepatitis C in the vast majority of patients following short, 12-week courses of treatment. This has been one of the greatest medical revolutions in the last 20 years,” says George Ioannou, MD, MS, FAASLD; associate professor of medicine at the University of Washington School of Medicine; director hepatology at Veterans Affairs Puget Sound Health Care System; and lead investigator in the study. “The question is whether we are delivering these medications to the patients who need them and what obstacles there are to treating and curing the majority of hepatitis C infected patients.”
Dr. Ioannou’s team identified 107,079 instances of hepatitis C antiviral treatment regimens being used in the VA healthcare system between 1999 and 2015. They defined treatment rates and cure rates based on the documentation a negative HCV viral load (i.e., no signs of the virus) at least 12 weeks after the end of treatment.
Between 1999 and 2011 (called the interferon era), the researcher noted antiviral treatment rates were low (1,989 to 7,196 treatments per year), and this did not increase after the introduction of the first DAAs in 2011, which had to be used in combination with interferon. From 2011 to 2013, the treatment rates were 2,943 to 5,207.
In contrast, the introduction of newer DAAs in 2013 and 2014 were followed by dramatic increases in annual treatment rates – with 9,180 treatments in 2014 and 31,028 in 2015. The number of veterans who achieved eradication of hepatitis C virus (i.e., cure) increased even more dramatically from less than 2,300 per year in the interferon era to 6,957 in 2014 and 28,084 in 2015. The introduction of interferon-free DAAs resulted in a 12-fold increase in annual HCV cure rates. Very importantly from the patient’s perspective, the success rate of an antiviral treatment regimen increased from approximately 20 percent in 1999 to more than 90 percent in 2015.
Next, Dr. Ioannou’s team looked more closely at the year 2015 and noted great fluctuations in monthly treatment rates ranging from 800 per month in July of 2015 to 7,000 per month in September. These fluctuations correlated mostly with the availability of funds for DAA treatment within the VA healthcare system. The most important factors that limited treatment in 2015 were the availability of funds to use on DAA treatments and the cost of the treatments themselves, not access to care or identification of eligible patients.
“The introduction of effective direct antiviral agents together with the allocation of appropriate funds and resources allowed the VA healthcare system to treat and cure hepatitis C in unprecedented numbers,” explains Dr. Ioannou. “In fact, out of approximately 57,500 patients cured of hepatitis C in the VA since 1999, approximately half (28,084) were cured in a single year – 2015.”
In 2016, there have been further increases in funding and reductions in cost for DAAs in the VA system. As of February 2016, the VA is providing unrestricted access to all DAAs for all eligible patients. This, combined with the trends over the past 16 years, leads Dr. Ioannou to believe the VA is potentially within three years of curing the majority of U.S. veterans with HCV.
“The VA has taken a lead in the nation in providing unrestricted access to hepatitis C antiviral medications, and this will result in even more impressive increases in treatment and cure rates and eradication of the vast majority of hepatitis C cases in the VA,” says Dr. Ioannou. “For hepatitis C eradication to become a reality in the whole country two things need to occur. First, other federal and non-federal third party payers need to provide unrestricted access to DAAs. Second, the cost of DAAs needs to be substantially reduced.”
Dr. Ioannou will present the study entitled “Towards eradication of hepatitis C virus infection in the Veterans Affairs national healthcare system: a study of 107,079 antiviral treatment regimens administered from 1999-2015” at John B. Hynes Veterans Memorial Convention Center in Boston on Monday, November 14 at 5:45pm in Ballroom BC. The corresponding abstract (number 227) can be found in the journal, Hepatology – Special Issue: The 67th Annual Meeting of the American Association for the Study of Liver Diseases: The Liver Meeting 2016.
About the AASLD
AASLD is a medical subspecialty society representing clinicians and researchers in liver disease. The work of our members has laid the foundation for the development of drugs used to treat patients with viral hepatitis. Access to care and support of liver disease research are at the center of AASLD’s advocacy efforts.
AASLD is the leading organization of scientists and healthcare professionals committed to preventing and curing liver disease. AASLD was founded in 1950 by a small group of leading liver specialists and has grown to an international society responsible for all aspects of hepatology.
SOURCE American Association for the Study of Liver Diseases (AASLD)