Authored by: Michael A. Mitcheff, DO, MBA, CCHP
Recently, ACH has fielded many questions on the topic of hepatitis C. I suspect many of our clients have similar questions.
My intention is to provide a basic understanding of hepatitis C and the controversy surrounding treatment. I hope to also provide guidance on how to address patients with hepatitis C who are requesting treatment.
Hepatitis C (HCV) is most commonly acquired through IV drug abuse. There are approximately 2.7 million people with chronic HCV. When patients “test positive” for HCV, via an antibody test, it is important to know that approximately 20% of those people clear the virus from their system spontaneously and don’t have chronic hepatitis C.
The reason for the recent controversy surrounding treatment is based on the fact that the newer agents that are now being used are shorter in the duration of treatment (most people 12 weeks vs. one year in the past), are much less toxic and much more effective with cure rates over 90%. The disadvantage is the cost which averages about $55,000 for a 12-week treatment. The corrections industry has a disproportionally high share of patients with HCV (approximately 10x the non-incarcerated population). Treatment DOES NOT prevent one from getting re-infected (making addiction treatment reasonable).
Some important points to consider are:
- The standard of care in a jail setting is to maintain the current state of health. In a prison, it is the community standard
- It takes 15 – 20 years for any significant liver damage to take place in the average person.
- Certain patients, such as those with HIV, progress faster and are a higher priority for treatment.
- Approximately 20% of untreated patients will develop cirrhosis and liver cancer, which means 80% do not.
- The majority of patients with chronic HCV are asymptomatic and only discovered on routine testing.
- Treatment must, however, be continued if the patient gets incarcerated during the 12-week course of treatment or we are open to liability.
- Most organizations such as Medicaid are risk stratifying by using an APRI score (simple calculation with bloodwork), looking at co-morbidities (such as HIV) and putting people into a treatment queue. The sickest or most likely to progress are treated first.
- The significant majority of our patients in the jail setting can be safely and appropriately deferred until they leave.
We at ACH are here to help our clients in any way we can. We suggest if you have a patient insisting on treatment that myself or our Senior Counsel, Jessica Young, Esq., CCHP, get involved. We will guide the clinical team on any testing that may be necessary and discuss any potential risk, of not treating this particular patient, with you.