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2003 Policy Positions
of the Southern Legislative Conference

5. IN ACKNOWLEDGMENT OF “HEPATITIS C” AS A NATIONAL HEALTH CRISIS


 BACKGROUND

     Hepatitis C virus infection (HCV) is a “silent epidemic” and is the most common chronic blood-borne viral infection in the United States.  It is a life-threatening disease that the Centers for Disease Control and Prevention (CDC) conservatively estimates infects 4 million persons in the United States.  According to the CDC and the National Institutes of Health (NIH), 85 percent, or approximately 2.7 million persons, are chronically infected, with a very small percentage of Americans aware of their infection because they are not chronically ill.  Hepatitis C can go undiagnosed for years since these patients do not initially experience or show symptoms for roughly 10, 15 or 20 years.  These infected people serve as a source of transmission to others, and are at risk of chronic liver disease, liver cancer and other HCV-related diseases such as Type II diabetes, autoimmune diseases and other life-threatening conditions that all can lead to liver failure.  In 1998, there were approximately 41,000 newly-infected Hepatitis C patients per year, accounting for roughly 25,000 deaths per year.  Hepatitis C is now the leading cause of liver disease, and it is estimated to increase the death rate over the next 10 years to 30,000 per year.  Hepatitis C is associated with advanced liver disease making it the most frequent indication for liver transplantation among adults.  Cirrhosis of the liver develops in 10 percent to 20 percent of all HCV patients and liver cancer in up to 5 percent of patients.  For individuals with cirrhosis, the rate of liver failure development can be as high as 1 percent to 4 percent per year, and is exacerbated by consumption of alcohol.  Because alcohol is an important contributing factor in the progression of chronic liver disease among persons with HCV, it is important to identify infected individuals as early as possible so that they can be educated about the virus and liver disease.  Hepatitis C is three or four times more prevalent in the United States than HIV/AIDS, and approximately 33 percent of all HIV-infected persons are co-infected with HCV.   

There is not a vaccine or cure for Hepatitis C; however, there are treatments available that can slow disease progression.  Unfortunately, only 200,000 to 400,000 of the four million people with HCV currently are receiving treatment.  Without early screenings for HCV, the disease process can become advanced, and in most cases is already advanced upon diagnosis.  Long-term follow-up studies are needed to assess lifetime consequences of chronic HCV infection in different populations, especially among children. 

     Excluding the high cost of liver transplantation, the cost per patient living with HCV is escalating.  Conservative estimates place costs of HCV at more than $600 million annually in the United States.  These costs will escalate dramatically as new diagnoses are made with education and prevention programs.  Costs to health care, society and productivity are greater still, including the high rate of uninsured in the United States.

     Individual states likely will have to take on more of the burden.  Research presented during the 50th Annual Meeting of the American Association of the Study of Liver Disease (AASLD) in 2000 showed the costs of the years between 2010 and 2019 to be estimated at $93 billion annually.  Much of this cost is attributed to new diagnosis of existing disease and of these, $20 billion represents a low estimate of medical costs, with $73 billion in lost productivity and disability costs.  A recent report published in the American Journal of Public Health by Tufts University predicts that decompensated cirrhosis and liver cancer in persons younger than 56 at the cost of $21.3 billion and $54.2 billion, respectively.  These estimates partially depend on the extent of alcohol consumption.  Costs also will continue to escalate as other autoimmune diseases and conditions occur that are associated with HCV, such as Type II diabetes.     

 RECOMMENDATION

The Southern Legislative Conference of The Council of State Governments recognizes the national health challenges created by Hepatitis C and encourages prevention and education activities in state and local public health programs to counsel persons at risk for HCV infection.  Further, the SLC recommends the consideration by states in the development of programs to promote the availability of Hepatitis C-related treatment for persons of all ages and incomes.  Furthermore, the SLC urges states to monitor and evaluate the infection rate, conduct outreach and community-based programs on the risk factors, when appropriate, and urges professional education of health care professionals based on current information concerning diagnosis, medical management and prevention recently described by the Centers for Disease Control and Prevention.  

 

 Adopted by the Southern Legislative Conference, August 12, 2003, Fort Worth, Texas.

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