You would think so. But the insurance industry may not want to see the facts, and prefer to focus on short term claim expenses, rather than long-term outcomes or the welfare of the insured.
Tig said
Sep 8, 2017
It has been proven time and again, early treatment saves lives and money!
LamontCranston said
Sep 8, 2017
Kaiser Permanente claims to be conducting wide-spread screening, but I have seen no evidence of this in my experience. This news article was published by Kaiser in Maryland, so maybe they are doing things differently on the East Coast. Kaiser is based here in the San Francisco Bay Area where I live, but I haven't heard a peep about the program mentioned here. goo.gl/yF7QTj
There may be some reluctance to do screening on a grand scale considering the cost of treatment. HMOs on the other hand may be inclined to screen and treat as soon as possible, due to the high cost of liver transplants or caring for members with hepatic failure. I read someplace that a liver transplant costs about 600,000 USD, about 6 times the cost to treat with Harvoni or Epclusa.
Tig said
Aug 31, 2017
Universal HCV screening is a pathway to eradication
Infectious Disease News, August 2017 Michael S Saag, MD
When we think about the possibility of universal screening, we can dance around, trying to dig out baby boomers or injection drug users, we can look at different risk factors or select populations, but I am not satisfied with that. We need to go for full blown eradication, and if we are going to do that, we must screen everyone and get those who test positive into treatment.
We are dealing with an epidemic that we can eliminate. So if we are going to think about eliminating this virus like we have done with smallpox, we should be serious about it. A good place to start is a public health approach. Namely, testing and treating. It is simple to say that everybody needs to be tested at least once for HCV, period.
Michael S. Saag
The next step is to consider how we are going to treat everyone who tests positive. In the United States, we need to think outside the box and look at the ways other countries have approached the epidemic. Australia has shown us that it is possible to make a deal to pay for medications without paying on a per-unit basis. They pay the drug company a certain amount of money to provide the country with as much drug as they can use for a finite period. I characterize this as a win-win-win. The company makes money, the government saves money because it is a finite, predetermined amount, and of course, patients are cured. Patients are motivated to enter the system because of the time limit. This kind of creative thinking will give the U.S. a legitimate shot at eradication. If we continue with the piecemeal approach we have been using, we will continue to see new cases, and the cost will be unconstrained.
Next, we need to learn from the mistakes we made with baby boomers. Again, in a piecemeal fashion, providers are only so motivated to perform the test. And owing to competing priorities, testing was not universally performed. Also, there was no plan of action for referring patients who tested positive into care. Or, even if they were referred to care, the cost of therapy was prohibitive. “Boomer” screening was a good idea but, ultimately, a failed approach. So why would we want to keep doing that in different populations?
If I told you right now I had a cure for HIV that required only 12 weeks of treatment, there would be heavy motivation to test, treat and eradicate. I cannot understand why the same mindset has not been applied to HCV. One possibility is that there is a great deal of activism surrounding HIV and hardly any activism in HCV. HIV went mainstream. We need a motivated public to insist that HCV is a priority, and we, as providers, need to take part in that effort.
Where there’s a will, there’s most certainly a way. Let’s get it done.
Editor’s Note: A version of this article appeared in HCV Next.
For more information:
Michael S. Saag, MD, is associate dean for global health at the University of Alabama at Birmingham School of Medicine, director of the UAB Center for AIDS Research and a professor of medicine in the division of infectious diseases.
Disclosure: Saag reports no relevant financial disclosures.
You would think so. But the insurance industry may not want to see the facts, and prefer to focus on short term claim expenses, rather than long-term outcomes or the welfare of the insured.
It has been proven time and again, early treatment saves lives and money!
goo.gl/yF7QTj
There may be some reluctance to do screening on a grand scale considering the cost of treatment. HMOs on the other hand may be inclined to screen and treat as soon as possible, due to the high cost of liver transplants or caring for members with hepatic failure. I read someplace that a liver transplant costs about 600,000 USD, about 6 times the cost to treat with Harvoni or Epclusa.
Universal HCV screening is a pathway to eradication
Infectious Disease News, August 2017
Michael S Saag, MD
When we think about the possibility of universal screening, we can dance around, trying to dig out baby boomers or injection drug users, we can look at different risk factors or select populations, but I am not satisfied with that. We need to go for full blown eradication, and if we are going to do that, we must screen everyone and get those who test positive into treatment.
We are dealing with an epidemic that we can eliminate. So if we are going to think about eliminating this virus like we have done with smallpox, we should be serious about it. A good place to start is a public health approach. Namely, testing and treating. It is simple to say that everybody needs to be tested at least once for HCV, period.
The next step is to consider how we are going to treat everyone who tests positive. In the United States, we need to think outside the box and look at the ways other countries have approached the epidemic. Australia has shown us that it is possible to make a deal to pay for medications without paying on a per-unit basis. They pay the drug company a certain amount of money to provide the country with as much drug as they can use for a finite period. I characterize this as a win-win-win. The company makes money, the government saves money because it is a finite, predetermined amount, and of course, patients are cured. Patients are motivated to enter the system because of the time limit. This kind of creative thinking will give the U.S. a legitimate shot at eradication. If we continue with the piecemeal approach we have been using, we will continue to see new cases, and the cost will be unconstrained.
Next, we need to learn from the mistakes we made with baby boomers. Again, in a piecemeal fashion, providers are only so motivated to perform the test. And owing to competing priorities, testing was not universally performed. Also, there was no plan of action for referring patients who tested positive into care. Or, even if they were referred to care, the cost of therapy was prohibitive. “Boomer” screening was a good idea but, ultimately, a failed approach. So why would we want to keep doing that in different populations?
If I told you right now I had a cure for HIV that required only 12 weeks of treatment, there would be heavy motivation to test, treat and eradicate. I cannot understand why the same mindset has not been applied to HCV. One possibility is that there is a great deal of activism surrounding HIV and hardly any activism in HCV. HIV went mainstream. We need a motivated public to insist that HCV is a priority, and we, as providers, need to take part in that effort.
Where there’s a will, there’s most certainly a way. Let’s get it done.
Editor’s Note: A version of this article appeared in HCV Next.
Disclosure: Saag reports no relevant financial disclosures.