Background:

According to the Center for Disease Control and Prevention (CDC), hepatitis C results in more deaths than any other infectious disease. Approximately half of the people with hepatitis C virus (HCV) do not know they are infected and a large percentage of the cases go undiagnosed. As a result, the prevalence of the virus is vastly underreported.

Hepatitis C first takes the form of an acute infection within 6 months of initial exposure to the virus. Spontaneous viral clearance occurs in approximately 15 to 25 percent of individuals with an acute HCV infection. However, more often (75 to 85 percent of cases), an acute HCV infection progresses to its chronic form. After being left untreated for years, a chronic hepatitis C infection can lead to liver cirrhosis (after 20-30 years), liver cancer, and/or liver failure. Fortunately, over 90 percent of HCV infected individuals can now be cured via an oral medication regimen for 8 to 12 weeks, regardless of HCV genotype.

As of 2017, 3.5 million Americans are living with a HCV infection. In 2016 alone, 2,967 acute cases of hepatitis C were reported. Due to issues with under-reporting, the actual number of acute cases is calculated to be 13.9 times the reported cases (41,200). In 2016, 18,153 death certificates indicated that HCV played a role in mortality.

Introduction:

Of the 3.5 million Americans living with hepatitis C as of 2017, 75 percent are baby boomers. This discrepancy is further illustrated by that fact that the generation born from 1945-1965 is six times as likely to be suffering from a hepatitis C infection than any other age group.

However, it is the 20 to 29-year-old demographic that is experiencing the most rapid increase in hepatitis C infections. This surprising trend is most likely the result of the injection drug use and needle sharing associated with opioid epidemic. Currently, injection drug use is the most prevalent means of HCV infection transmission. A review across multiple states of “people who inject drugs” (PWID) analyzed the presence of HCV infection in these population. It came to the conclusion in 2017 that 53.1 percent of PWID were infected (with a given range of 38.1 to 68.0 percent).

Siryaprasad et. el. (2014) looked in depth at hepatitis C infections in young people (30 years of age or younger) from 2006 to 2012. The study found that acute hepatitis C infections increased 13 percent annually in nonurban counties and 5 percent annually in urban counties. 75 percent of interviewed participants indicated they had previously injected drugs.

Another demographic with an increase in HCV infection is women of reproductive age (15-44 years of age), especially in more rural regions, such as the Appalachians. In this case, not only is the mother vulnerable to the effects of hepatitis C, but her newborn can face exposure to the virus at the time of birth. The risk of a HCV infected mother transmitting the virus to her child is approximately 4 to 7 percent. Increased rates of HCV detection were seen nationwide for both women of childbearing age and children under the age of two from 2011 to 2014. National HCV detection increased by 22 percent (for reproductive-aged women) and 14 percent (for children two years of age or younger). In Kentucky, there was in  increase of 213 percent (for reproductive-aged women) and 151 percent (for children two years of age or younger).

Taking Action:

According to a Journal of the American Medical Association article co-authored by Senator Cassidy (R-LA), Louisiana has a high prevalence of HCV infection but a low rate of treatment. Secretary of the Department of Health, Rebekah Gee, supported this conclusion by stating that treatment of all hepatitis C infected people in Louisiana would cost approximately $760 million. Louisiana currently spends around $35 million annually on the treatment of hepatitis C infected people (which covers less than 3 percent of infected Medicaid patients and 1 percent of the prison population).

Louisiana is attempting to lower costs for hepatitis C medications via the replacement of the per-prescription revenue model with a subscription-based payment method to drug makers. Media outlets have dubbed this the “Netflix model,” after the widespread subscription-based streaming platform. Through Netflix, subscribers pay a monthly flat fee for unlimited access to content. Similarly, via the subscription-based model, the state would pay a fixed amount annually for access to an unlimited amount of medication to treat Medicaid patients and prisoners. This is intended to more effectively provide HCV treatment on a population-based level. This model could provide insight towards HCV treatment in the United States. as a whole; currently, only 15 percent of the HCV infected population has actually received treatment.