Consistent funding of Veterans Affairs healthcare operations could lead to the cure, within three years, of more than 90 percent of military members currently being treated for hepatitis C, new research suggests.
More timely funding and lower medication costs have enabled the VA to take great advantage of antiviral agents that came to market in 2013: Indeed, the 28,084 VA patients whose hepatitis C virus was eradicated in 2015 nearly equaled its samesuch patients cured from 1999 to 2014.
“We now have well-tolerated, safe and effective medications that can eradicate hepatitis C in the vast majority of patients following 12-week courses of treatment,” said lead investigator Dr. George Ioannou, associate professor of medicine at the University of Washington School of Medicine. He directs hepatology at the Veterans Affairs Puget Sound Health Care System.
“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.”
Ioannou will present his findings Nov. 14 in Boston at a national meeting of the American Association for the Study of Liver Diseases. Hepatology journal has published the corresponding abstract (scroll to No. 227).
The emergence of direct-acting antiviral agents, delivered to patients over 12 to 24 weeks, has revolutionized the care of viral hepatitis. Ioannou and colleagues examined the VA’s funding for antiviral agents and their effectiveness with VA patients to determine the drugs’ greatest potential impact among that population.
They first identified 107,079 instances of hep C antiviral regimens prescribed in the VA healthcare system between 1999 and 2015. They defined treatment rates and cure rates based on documentation of a negative viral load – that is, no signs of the virus – at least 12 weeks after treatment ended.
From 1999 to 2011, when interferon was the primary treatment for hep C, antiviral treatment rates were relatively low (1,989 to 7,196 per year) and remained so after the first direct-acting antivirals – used in concert with interferon – appeared in 2011. From 2011 to 2013, VA treatment rates were 2,943 to 5,207.
Antivirals that emerged in 2013 and 2014 were followed by dramatic increases in annual treatment rates: 9,180 in 2014 and 31,028 in 2015. Veterans whose hepatitis C virus was eradicated, or cured, under VA care increased from less than 2,300 per year in the interferon era to 28,084 in 2015.
Moreover, the success rate of an antiviral treatment regimen increased from approximately 20 percent in 1999 to more than 90 percent in 2015.
The researchers noted curiously large fluctuations in monthly treatment rates during 2015, ranging from 800 in July to 7,000 in September. These fluctuations, they discovered, correlated mostly with the availability of VA healthcare funds for the drug treatment as well as the cost of the medication itself.
Since February 2016, the VA has provided unrestricted all eligible patients with access to direct acting agents. This, in light of recent years’ trends, leads Ioannou to think that the VA may be within three years of curing the vast majority of U.S. veterans with hepatitis C.
“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 (direct acting antivirals). Second, the cost of DAAs needs to be substantially reduced.”
Source: University of Washington