A Tale of Two Epidemics - HCV Treatment among Native Americans and Veterans
Brigg Reilley, M.P.H., and Jessica Leston, M.P.H.
In light of ongoing debates about health care budgets and rising drug prices, a current public health crisis can provide useful insights. For patients who get their health care through two separate federal agencies, the hepatitis C virus (HCV) epidemic is unfolding in vastly different ways. In recent years, the Department of Veterans Affairs (VA) health care system has mounted a response to HCV that should be the envy of any health system, public or private
, the Indian Health Service (IHS), an agency that serves American Indians and Alaska Natives, is struggling to meet the needs of its patients with HCV.
Hepatitis C is a chronic viral infection that affects an estimated 3.5 million Americans. The majority of these people were exposed to the virus decades ago, and many of them still don’t know they are infected, since HCV often remains asymptomatic for many years as it silently damages the liver. Risk factors for HCV infection include injection-drug use and historical medical exposures (such as through blood transfusion prior to 1996). The virus is the driving force behind increasing rates of liver cancer in the United States, and it kills more Americans than 60 other notifiable infectious diseases, including HIV, combined. In recent years, breakthroughs have resulted in medications that can reliably cure HCV, often by means of a single pill taken once a day for just 12 weeks. These new medications allow primary care providers to take an active role in the elimination of HCV infection. Now the biggest barrier is cost: the retail price of each pill is more than $1,000.
(Adapted from: New England Journal of Medicine, August 31, 2017)
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