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Recommendations for when and in whom to initiate treatment

Have you all seen this?

The new AASLD HCV Guidelines with the addition of "Recommendations for when and in whom to initiate treatment" in which they set criteria for who should get treatment first. It sounds like they are suggesting providers not treat people lower down on their priority list until those highest on the priority list have been treated and I'm just curious as to whether or not people think doctors will actually follow these guidelines. Do you think the insurance companies will use these guidelines to deny treatment in the future?

I thought for sure someone on this site would have brought it up but I can't find the topic anywhere. Perhaps I have missed it.

Anyway, those who have highest priority are those with advanced fibrosis and compensated cirrhosis.

http://www.hcvguidelines.org/full-report/when-and-whom-initiate-hcv-therapy
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Avatar universal
Call me naive but why can't anyone with HCV treat right away? Because our economy would fall apart? Hardly. Bottom line is money would actually be saved in the long run. If we had a virus such as Ebola, you know we would all be treated immediately and our economic system would still be secure. People in general only care when it affects their own health and well-being.

With regard to finding a way, I've yet to find it. :) But, I think it has a lot to do with where I live and not being able to find a doctor outside of the university or another large system due to my Medicare.

Overall, I do think the guidelines are good and that's because there are indeed few specialists available and it takes months just to get in. If I had been willing to accept Interferon with Riba and Sovaldi, I'd be done by now. Still working on S/O.
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766573 tn?1365166466
If I apply the standards to myself I would not be a priority. I am only stage one and did 48 weeks weeks of Triple with Incivek. I had zero out of pocket expenses for both the HCV & the rescue meds. Half way through treatment the symptoms of a very debilitating condition (called Secondary Reynaud's) disappeared and is completely gone. Though some research reveals this could have been considered an extrahepatic manifestation the rheumatologist and my PCP were stunned it happened. My Gastro was not all that surprised. The point is I am not sure I would have grounds for much of a fight to get the insurance company to cover treatment and thus would not have been a priority.

Since I treated once and failed back in 07 I knew how to plan and I had the resources to treat.  I am acquainted with several folks who according to those guidelines are not a priority who are currently treating or planning to very soon. People who one way or another have found a way. The way our system is currently structured enabled this to happen.

I guess that, in part is the reason the terms, "Limitations of workforce and societal resources" threw me. I don't mean to harp on that but the notion sounds almost European. I am not saying it is not a good idea or does not make sense; I don't see how deciding who gets to treat and when would work in America unless insurance companies or other payor sources followed these guidelines.
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Avatar universal
The warehousing of patients has never had anything to do with being poor but better and easier treatment options that were close to being approved. As a matter of fact a very large amount of people here are provided all of these drugs at low or no cost do to programs provided by these drug companies. Even the "Rescue drugs that were needed.
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Avatar universal
If these recommendations are accepted by treating providers, then insurance will have strong ground for denial of those who are not high priority. Since I am F4 and still compensated I am not so concerned about myself, but rather those who say may "only" be F3 and for some reason rapidly move into cirrhosis. If these guidelines are followed by most doctors, then inevitably there will be some people who develop damage that they would not have if treated sooner.
The thing with warehousing people is that those with money invariably continue to receive the best treatment while the poor must wait. While I realize most people do not have a problem with the poor and lower classes doing without healthcare, I just feel it is very wrong on many levels.
Off my high horse now...
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Avatar universal
True Idyllic. But hasn't that always been the case? I remember when we just had SOC treatment and people were needing to extend some insurance companies balked at the ideal while others didn't. Then when the PI's first came about we had the same thing. It has seemed though that a good doctor can usually work through this... Hope all is well with you.
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766573 tn?1365166466
I'm cool with these things being recommendations for doctors to think about; it is insurance companies that make me a little wary.
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Avatar universal
I'm not sure what the confusion is about this as these recommendations has always been there. At least by most of the top Hep doctors for as long as I can remember. "warehousing" patients has not been that uncommon for years. To think everyone that has Hep C could treat at once would make and impossible case load on doctors.

Stage 3 and 4 should be top priority to start treatment and stage 2 should be next. Those that are stage 0 or 1 can wait unless there are other certain Extrahepatic manifestations that are prioritized as they should be. As for post TP patients unless the need is now then seeing what is in current trials that seem to be having great results with cure rates is also something to think about.

Remember this is just recommendations for doctors to think about, nothing more. Doctors can and do start treatment when they feel the need and the patient is willing... Just my opinion.
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Avatar universal
We are at a critical juncture as medical history is being made. Gileads top CEO's and president are under investigation before a senate committee in Wash. DC as Uncle Sam wants answeres as to why the prices are so high. These prices pose a real threat to the medical system, and when the new miracle drug is on the market in autumn thye cost isintended to be even higher than 1K per pill. As it stands the only way this whole thing is going to work is if the drug is rationed, i.e. given to the priority (F-3/4 cirrhotic) only. As time goes by either the price will drop and/or the chemistry of the drug be easier to obtain and produce. The drug actually does cost $200. to make in the labs and is retailed at 1,000. If given a chance to change places with a non-cirrhotic and forego tx Id do it in a heartbeat. Unfortunately Ive no choice. It treat or die slowly at this point.
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Avatar universal
It comes down to cost.  
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Avatar universal
hi Rubye
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Avatar universal
Unbelievable really..
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Avatar universal
My real simple take is AASLD think doctors should limit who they treat and that only those with f3 fibrosis and compensated cirrhosis should get treated now and all the other people with Hep C will just have to wait.

I am hoping someone will say why I'm mistaken because this is so very wrong.
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766573 tn?1365166466
Wow I thought this would have something to do with clinical management or the Standard of Care for Hepatitis C.
I wish others would comment on this. I skimmed through it and appreciate in theory the classifications and rating structure as well as the assessment. I guess what I keep stumbling on is the introductory paragraph:

Limitations of workforce and societal resources may limit the feasibility of treating all patients within a short period of time. Therefore, when such limitations exist, initiation of therapy should be prioritized first to those specific populations that will derive the most benefit or have the greatest impact on further HCV transmission. Others should be treated as resources allow.



Namely it is the "Limitations of workforce and societal resources" part.

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