One thing likely to accelerate demand for treatment: Medicare is expected to approve payment for routine blood tests for hep-C infection soon. That will reveal many people who don't yet know they're infected - and spark difficult conversations between patients and doctors on when to use the expensive new medications to clear the virus from their blood.
Many hepatitis specialists and patient advocates are worried that the cost of the drugs will lead payers to limit access to patients who already have advanced liver disease, or even more narrowly, those who are on transplant waiting lists.
"We're very scared that these programs to limit access to treatment could interfere with our goals of trying to find people with hepatitis C," Graham says.
Ryan Clary of the National Viral Hepatitis Roundtable, a patient advocacy group, says public health may be on a collision course with treatment and reimbursement policy.
"On the one hand, we're saying 'Now is the time to be tested for hep-C. There are these promising treatments,'" Clary says. "But on the other hand, we're saying 'You can't have access to these cures. It'll bankrupt the country.' So where's the incentive to test?"
Apart from expensive drug treatment aimed at cure, doctors say there are other good reasons for identifying infected patients. They can be counseled to stay away from alcohol, which accelerates hep-C related liver damage. They can also be told about steps to take to avoid infecting others.
There are other implications of delaying treatment until liver damage is advanced. Once a patient has developed cirrhosis, he'll need to be monitored every six months for the rest of his life for signs of liver cancer.
And if a patient tips into liver failure or cancer before getting cured, treatment will cost an estimated $50,000 a year - possibly over several years.
"Hepatitis-C is a ticking time bomb," Graham says. "We have a very limited amount of time to get in here and alter the course of the disease for a good number of people. And we either do that, and we do it well now, or we face a whole lot more people suffering severe complications of this disease."
Fri, May 09 2014