VA Health Services
Research
An Integrated Care Model
for Improving HCV
Patient Outcomes
Samuel B. Ho MD
VA
San Diego Healthcare
System, San Diego, CA
San Diego, CA
Funding
Period: November 2008 -
October 2013
The
prevalence of
hepatitis C virus
(HCV) infection
among VA patients is
3x higher than in
the general
population. Recent
VA data indicate
that only about 14%
of all HCV-infected
VA patients have
ever received
antiviral therapy
http://hcvets.com/data/va_health_services_research.htm
U.S.
National Institutes of
Health
VA Clinical trial HCV &
Depression
Hepatitis C Translating
Initiatives for
Depression Into
Effective Solutions (HEPTIDES)
This
study is
sponsored
by
Department
of
Veterans
Affairs
and
currently
recruiting
participants.
Verified
November
2012
ClinicalTrials.gov
Identifier:NCT01143896
First
received:
June 11,
2010
Last
updated:
November
1, 2012
Last
verified:
November
2012
However,
~70% of veterans with
CHC are considered
ineligible for antiviral
treatment. Most of these
patients are excluded
due to the presence of
co-existing depression
and substance use. The
proposed project will
adapt and adopt an
evidence-based
collaborative depression
care model in CHC
clinics. Read more:
http://hcvets.com/data/hcv_liver/TreatmentOptions/VetStudyINFDepression.htm
Why 88% of US
Military Veterans with HCV are not
Treated by
the Veterans Administration
Dr. Ben
Cecil, is a physician
that specializes in
hepatitis C virus (HCV
Disease). He is employed
by the
Louisville, KY Veterans
Affairs hospital.
Recently, he
responded to a study
published in the
February Journal of
Hepatology stating,
"The Veterans
Administration does not
want to spend adequate
funds to cure patients
with hepatitis C. The
high priority to treat
Veterans has changed
since Dr. Kenneth Kizer,
Under Secretary for
Health in the US
Department of Veterans
Affairs (VA), left the
VA in 1999. The
subsequent leadership
has not shown enthusiasm
for treating HCV".
The
Houston VA study that
Dr. Cecil responded to,
"Gaps in the achievement
of effectiveness of HCV
treatment in national VA
practice",
identified 99,166
patients with HCV
disease. Of those, 11.6%
received PEG-INF with
ribavirin and only 6.4%
completed treatment.
Overall, only 3.5% of
the entire HCV cohort
had a documented
sustained viral response
(SVR).
Dr.
Cecil points out between
2000 and 2008, the
annual number of all
cause deaths recorded
for Veterans with
chronic HCV rose from
1259 (1129 per 100,000
in VHA care) to 5967
(4049 per 100,000 in VHA
care), respectively.” Less than
2% of Americans die from
liver disease, but more
than one third (36%) of
veterans with HCV die
prematurely from
complications of
cirrhosis.
In 2008,
VHA clinicians cared for
over 147,000 veterans
with chronic HCV
disease. Treating 4500
patients with HCV in 20
months is only 225
patients per month. The
VA is currently treating
less than 2% of infected
veterans per year the new
antiviral drugs,
Boceprevir and
Telaprevir.
Dr Cecil
says the trend "not to
treat", is expected to
continue despite the
more effective drugs now available. The
Director of Pharmacy and
the Chief of Staff at
his local VA hospital
told him that he spent
too much money treating HCV.
Boceprevir and
Telaprevir, are both on
the hospital formulary
but Telaprevir
prescriptions are
routinely denied because
it is more expensive.
Patients must jump
multiple hurdles before
qualifying for antiviral
therapy.
It will
take the VA
more than fifty years
to treat all of the HCV
patients. The allocated
$100 million provided
for antiviral therapy
over 20 months is $5
million per month. The
amount of money is
clearly inadequate to
treat 147,000 veterans
with HCV Disease. Dr.
Cecil insists this is
why legislation should
be passed so that all
veterans with HCV
immediately pre-qualify
for their choice of
Medicaid or Medicare.
Veterans could then
obtain antiviral therapy
in the private sector
instead of waiting for
the VA to treat 2% of
them each year. Now,
many are trapped in the
VA system while their
curable disease
progresses to liver
cancer, liver failure
and death.
Dr.
David Ross with National
Hepatitis C Program for
Veterans Health
Administration, in
Washington, DC,
responded to Dr. Cecil's
remarks in the Journal. He
discredits Dr. Cecil as
being just another VA
clinician who is
clueless to actual
findings. He closes by
saying, "As a VA
clinician who provides
care for Veterans with
HCV, I am proud of VA’s
HCV Program, which is
recognized as a national
leader in the integrated
care of patients with
this disease [10].
Although there is always
room for improvement in
any therapeutic service
in any health care
system, VA has been
striving to deliver
high-quality, evidence
-based care to as many
Veterans with HCV as
possible, and will
continue to do so.
HCVets are asked to
contact representatives for an
explanation how the VA can continue
to
blow it's own horn in the face of
denied treatment for Veterans with HCV
Disease, . Tell your representatives
we need funding to treat As
Dr. Cecil says, it will take 50
years to treat everyone.
Send this message
today! Help save the lives of
Veterans with HCV Disease.
Find your representatives.
weeks
after the end of
treatment) in the
entire cohort, and
among patients who
initiated and
completed treatment.
