March 24, 2015 / 3:30 PM / 4 years ago

Lack of insurance bars some from hepatitis C treatment

(Reuters Health) - Survey data from 2001 to 2010 show that lack of insurance kept some people with hepatitis C virus from getting treatment.

Recently, more effective and well-tolerated drugs have been developed to treat hepatitis C, removing many of the discouraging side effects of older drugs. The infection is curable and transmission can be prevented, researchers write in the American Journal of Gastroenterology.

But for the more than three million people in the U.S. who have chronic liver disease from hepatitis C, there are still two important barriers to getting treatment, said lead author Dr. Ivo Ditah from the Mayo Clinic in Rochester, Minnesota.

First, many people with the disease do not know they have it, because they feel no symptoms. Once they’ve been screened and tested positive, those without health insurance or with poor health insurance likely cannot afford the $250,000 to $350,000 price tag for medications and facility fees, Ditah said.

For the new study, he and his coauthors used National Health and Nutrition Examination Survey data, which includes blood testing for infections like hep C, from 2001 to 2010.

Of 38,025 people sampled, 502 tested positive for hep C and 205 were available six months later for follow-up testing. The rest, who tended to be less educated, injecting drugs or not have health insurance, could not be reached.

Half of those 205 patients said they were not aware of their infection until the surveys were done, and 166 pursued further testing or evaluation, but only 18 received therapy. Lack of health insurance coverage was the only predicting factor for who would not receive treatment.

“I think the message remains very strong that a lack of health insurance is going to be a major stumbling block,” Ditah told Reuters Health by phone. “We see a lot of denials from insurance companies not to cover these medications. It’s a huge problem.”

Hep C can be spread by sharing needles, being born to a mother who has the infection, and less commonly through sexual contact. Until the early 1990s, it could also be spread by blood transfusions, but now blood banks can test for the virus in stored blood.

Chronic liver infection can result in long-term health problems, including liver damage, liver failure, liver cancer, or even death, according to the Centers for Disease Control and Prevention. Hepatitis C is the leading cause of cirrhosis and liver cancer and the most common reason for liver transplantation in the U.S.

Up to 25 percent of people who get chronic hepatitis C will clear the virus on their own, while the rest require treatment, according to the CDC.

As newer versions of the best treatments are developed, those in use now will gradually become less expensive, and insurance coverage under the Affordable Care Act has expanded since 2010, Ditah said.

As more people get health insurance, the proportion of people with the infection who cannot be reached will continue to go down, he said.

The CDC recommends that all people of the “baby boomer” generation, born between 1945 and 1965, be screened for hepatitis C.

“Those recommendations should be followed. If they are found to have the infection then a good chunk will get treatment,” unless they don’t have good health insurance, Ditah said.

SOURCE: bit.ly/1BDtym6 American Journal of Gastroenterology, online March 10, 2015

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