Very interesting; thank you for the enlightenment--
Bill
This is the study that showed that out of 113,927 veterans under VA care with a diagnosis of HCV, only 11.8 % were approved for treatment.
Co
Who Gets Treated for Hepatitis C?
By Liz Highleyman
Many people with chronic hepatitis C virus (HCV) infection never receive treatment, for reasons ranging from minimal liver damage, to active substance use, to doctors fears about poor adherence.
As reported in the September 26, 2006 electronic edition of Gut, researchers conducted a study to determine the rate of hepatitis C treatment prescription and predictors of treatment in a large cohort of U.S. veterans. They used the Department of Veterans Affairs (VA) National Patient Care Database to identify all HCV-infected persons receiving care between 1999 and 2003. Demographic information, medical and psychiatric co-morbidities, and drug and alcohol use diagnoses were retrieved from patient records. Pharmacy data was retrieved from the VA Pharmacy Benefits Management database.
Results
• 113,927 veterans under VA care with a diagnosis of HCV were identified.
• The treatment prescription rate for hepatitis C was 11.8%.
• Patients not prescribed treatment were:
- Older;
- More likely to be of a minority race;
- More likely to use alcohol and/or illegal drugs;
- More likely to have medical and psychiatric co-morbid conditions.
• In a multivariate logistic regression model, the following factors predicted non-treatment of HCV:
- Increasing age (OR 0.77 for each 5 year increment);
- Black (OR 0.64) or Hispanic (OR 0.88) race;
- Alcohol (OR 0.62) or drug (OR 0.78) "abuse and dependence";
- Presence of anemia (OR 0.18);
- Hepatitis B co-infection (OR 0.72);
- History of stroke (OR 0.75);
- Coronary artery disease (OR 0.90);
- Mild depression (OR 0.56);
- Major depression (OR 0.72);
- Bipolar disorder (OR 0.64);
- Schizophrenia (OR 0.71).
• Factors associated with a higher likelihood of treatment for HCV were:
- Liver cirrhosis (OR 1.60);
- Diabetes (OR 1.07).
Conclusion
In conclusion, the authors wrote, "A small number of HCV infected veterans are prescribed treatment for HCV. Non-treatment is associated with increasing age, black race, drug and alcohol abuse and dependence and co-morbid illnesses."
These results suggest that many patients with hepatitis C are needlessly missing out on the benefits of treatment. The most recent National Institutes of Health consensus statement on hepatitis C treatment no longer recommends that active substance users be categorically excluded from anti-HCV therapy.
Medical conditions like anemia and psychiatric conditions like depression do present additional challenges during treatment, but in many cases these can be managed with adjunct medications such as antidepressants.
10/20/06
Reference
A A Butt, A C Justice, M Skanderson, and others. Rate and predictors of treatment prescription for hepatitis C. Gut. September 27, 2006
http://www.hivandhepatitis.com/hep_c/news/2006/102006_a.html
I meant 70 to 75% have genotype 1.
Co
90 to 95% of Vets have genotype 1. The VA approves treatment for 11.8% (it takes an average of two years to get treatment approval). Of those 11.8% that treat, only 19% reach SVR....because the VA uses old Tx guidelines which include dose reductions instead of Procrit or Neupogen.
"weight dosed rather than flat dosed"
They use 800mg for geno 2 and 3.
Co.
"Can anyone tell me if VA pays for treatments"
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Yes, they do....for the 11.8% they approve for treatment. The VA denies approval for ridiculous things like having depression, anemia, diabetes, or because you're considered non-compliant because you missed an appointment thery never told you about.
If you mention that you have had ANY amount of alcohol in the past six months, they may decide to postpone treatment or require that you attend an "alcohol addiction program".
Co
Ok, with GT-3, there’s not much benefit to waiting for the new protease inhibitor drugs; these are designed primarily with genotype 1 in mind. You have an approximately 70 % chance of success with standard treatment; make sure you are dosed adequately with the drug ribavirin; this should weight dosed rather than flat dosed. If you do treat, also discus how he/she intends to manage any side effects that arise; especially any problems with blood counts. These should be managed with rescue drugs rather than dose reduction of HCV meds, wherever possible.
Best to you, and let us know how things go, OK?
Take care—
Bill
Hey Bill,I am geno type 3a and I have had a biopsy.I havent read the report yet ,but doctors assit told me today I had moderate damage and doctor recommended treatment
Sure. Treatment costs without insurance can begin at about USD $60,000/year. It can be substantially more if drugs like Procrit and/or Neupogen are required to maintain red and white cell counts; about 25-30% of patients require some form of rescue drug like that.
Good luck with your appointment; do you know what genotype you have yet? This will help determine the efficacy and duration of treatment. Have you had a biopsy yet, or do you know if one is required?
All the best to you, and welcome to the discussion group—
Bill
thanks bill I have an appt tomorrow any idea (ballpark)what treatment will cost?