Congress confronts a once-in-a-generation chance to eradicate a disease that kills thousands of Americans annually and saves billions of dollars in the process.
The March proposal by the Biden administration to eradicate hepatitis C in the United States should make sense to both conservatives and progressives. Over the next decade, we predict that the initiative will prevent 20,000 cases of cancer, 49,100 cases of diabetes, and 25,000 cases of chronic renal disease. It will prevent 24,000 deaths.
To fund the initiative, the administration requests $12.3 billion over five years, including $7.2 billion in new funds and $5.1 billion reallocated from other programs.
Although this number may give deficit conservatives pause at first, our analysis demonstrates that over the next decade, healthcare cost savings will total $18.1 billion, with the federal government contributing $13.3 billion. The health benefits will more than double over the next 20 years, while the cost savings will triple.
Obviously, skeptics must be persuaded that all this upfront funding can effectively eradicate such a virulent disease.
In fact, highly effective medications with a cure rate of over 95% have been available for nearly a decade, but only one-third of hepatitis C patients have been cured. In consequence, more than 2 million Americans had chronic hepatitis C in 2020, and approximately 14,000 perished as a result of its complications.
When the cure first became available, it was expensive, costing up to $94,500 per patient. As a result, Medicaid and other insurers restricted access to the pills by requiring advanced liver disease as a prerequisite for treatment or by imposing high cost-sharing requirements on patients.
However, the cost of hepatitis C treatment is now approximately $20,000 per patient, making it cost-effective. To treat thousands of patients, however, requires an initial investment.
In addition, the viral attack on the liver can progress asymptomatically, leaving up to forty percent of infected individuals oblivious to their condition. In addition, hepatitis C is most prevalent among those with the least access to medical care, such as the indigent, the incarcerated, and injecting drug users.
The national initiative targets all of these obstacles. A National Academies of Sciences, Engineering, and Medicine Committee (of which one of us, Neeraj, was a member) endorsed the implementation of a national “subscription model” for procuring hepatitis C pills. The federal government would move from paying a different price for each drug to paying a single price for all pills.
Manufacturers would compete for the contract. The winning pharmaceutical company would recoup research costs, while the government would reduce expenditures through market competition and low manufacturing costs.
Medicaid, prisons, and the Indian Health Service would see an increase in access without exceeding budgetary constraints. The model could also serve as a guide for purchasing numerous other costly medications, such as promising weight loss remedies for the treatment of diabetes.
Hepatitis C affects baby boomers disproportionately, who are flooding into Medicare. Unfortunately, hepatitis C treatments are still prohibitively expensive for many Medicare recipients, with average out-of-pocket expenses of approximately $4,000.
In addition, the president’s initiative includes a copayment assistance program that eliminates Medicare out-of-pocket costs. This will not only improve the health and finances of seniors, but it also makes economic sense by reducing Medicare costs for liver transplants, liver disease complications, diabetes, and chronic renal disease.
The initiative would expedite the development of rapid tests identical to those that the government subsidized for COVID-19 in order to identify the carriers of the virus. Once available, the tests could be deployed at “test and treat” locations, where individuals could be tested and treated in a single visit.
Currently, physicians must order two tests to access cures, and many patients are lost while they wait for test results. The initiative would also fund a public health campaign to raise disease awareness and interventions to engage primary care physicians in the treatment of hepatitis C.
This strategy has been instrumental in reducing hepatitis C rates elsewhere. The World Health Organization has pledged to eradicate viral hepatitis by 2030, and a number of nations, including Egypt, Mongolia, and Rwanda, are well on their way to achieving this goal. The fact that such resource-limited nations have surpassed the United States should serve as a wake-up call to Congress.
It is possible to eliminate hepatitis C as a menace to public health in the United States while saving billions of dollars. It will necessitate abandoning short-term deficit reduction objectives. According to our projections, not all expenditures contribute to the federal deficit. When lives are saved and healthcare costs decline, there will be plenty of credit to go around if this initiative is approved.
