Level Maps Showing Impact of Hepatitis C Epidemic Across the U.S.

HepVu Releases State-Level Maps Showing Impact of Hepatitis C Epidemic Across the U.S.

ATLANTA, Jan. 16, 2019 – Today, HepVu launched new interactive maps visualizing state-level estimates of people living with Hepatitis C across the United States that highlight a concentration of infections in some states most impacted by the opioid epidemic. Published in JAMA Network Open, the data reveal an estimated 2.3 million people living with Hepatitis C infection in the U.S. between 2013 and 2016, with a high burden in the West and in some Appalachian states.

“We still have more than 2 million people living with Hepatitis C at a time when ending this epidemic is possible,” said Patrick Sullivan, Ph.D., DVM, Professor of Epidemiology at Emory University’s Rollins School of Public Health and Principal Scientist for AIDSVu. “Hundreds of thousands of Americans have been cured of Hepatitis C with newly available treatments, yet new Hepatitis C infections have nearly tripled in recent years as a consequence of increasing injection drug use associated with the opioid epidemic. At the same time, many older Americans, who have been living with Hepatitis C for decades, still remain undiagnosed and untreated. Halting the Hepatitis C epidemic requires a commitment across the nation to diagnose and cure people living with the virus and stop new infections before they erode our significant progress.”

Three-fourths of Americans living with Hepatitis C are Baby Boomers (those born between 1945 and 1965). However, the largest increases in Hepatitis C infections over the last decade have been among individuals less than 40 years old and particularly among persons who inject drugs.

“Hepatitis C and other infectious diseases are often-overlooked consequences of America’s opioid crisis,” said Eli Rosenberg, Ph.D., Associate Professor of Epidemiology and Biostatistics, University at Albany School of Public Health, State University of New York. “Our analysis helps to pinpoint the concentration of the disease geographically and shows the burden of Hepatitis C is greater in places highly affected by the opioid epidemic.”

Key findings include:
-The Western U.S. has the highest rate of people with evidence of Hepatitis C infection, with 10 of the region’s 13 states having an estimated Hepatitis C prevalence above the national median.
-There is also a concentration of Hepatitis C in Appalachia, likely related to the opioid epidemic in these states. Kentucky, West Virginia, and Tennessee are now among the 10 hardest-hit states.

-Nine states (California, Florida, Michigan, New York, North Carolina, Ohio, Pennsylvania, Tennessee, and Texas) represent more than half, or 52 percent of all persons with Hepatitis C nationally – and five of the nine states are in Appalachia.

“One of the most critical challenges in our national response to viral hepatitis is limited data that we can use to understand and monitor the epidemic,” continued Sullivan. “Accurate estimates of the burden of Hepatitis C infection in each state are essential to inform policy, programmatic, and resource planning for elimination strategies across the U.S. By mapping Hepatitis C in the U.S., HepVu seeks to provide a comprehensive picture of the disease’s impact on states to inform researchers and public health decision-makers’ prevention and care efforts.”

HepVu is a Powered By AIDSVu project presented by Emory University’s Rollins School of Public Health in partnership with Gilead Sciences, Inc. State-level Hepatitis C prevalence estimates on HepVu can be viewed alongside social determinants of health and data related to the opioid epidemic, including opioid prescription rate, narcotic overdose mortality rate, and pain reliever misuse prevalence. HepVu also visualizes data on Hepatitis C-related mortality (2016) obtained from the Centers for Disease Control and Prevention’s (CDC) WONDER Online Database System. Additionally, HepVu offers downloadable datasets for researchers and health departments to utilize in their own analyses, infographics on Hepatitis B and C, and state-specific factsheets.

The state-level Hepatitis C prevalence estimates displayed on HepVu are produced by the Emory University Coalition for Applied Modeling for Prevention (CAMP) project with researchers from the University of Albany and developed with CDC. Findings were published in the peer-reviewed Journal of the American Medical Association (JAMA) Network Open in an article titled, “Prevalence of Hepatitis C Virus Infection, US States and District of Columbia, 2013 – 2016”.

The new data are derived using an updated approach to the previously published methodology for 2010 state-specific Hepatitis C prevalence estimation that reflects current changes to the epidemic. To estimate state-level Hepatitis C prevalence, researchers analyzed blood test results from the nationally representative National Health and Nutrition Examination Survey (NHANES) and vital statistics data from 2013 through 2016, and incorporated data on Hepatitis C-related deaths and narcotic overdose deaths. The researchers also estimated the number of Hepatitis C infections among populations not included in NHANES, including incarcerated, unsheltered homeless, and nursing home resident populations. For more information on the data methods, please visit HepVu.org.

https://hepvu.org/hepvu-releases-new-maps/

No-haggle policy on drug pricing cost Medicare at least $14.4B

Becker's Hospital Review

No-haggle policy on drug pricing cost Medicare at least $14.4B, study finds

Written by Alia Paavola | January 15, 2019

Medicare Part D could have saved $14.4 billion on the top 50 medications covered in 2016 if the program had been able to pay the same prices as the Department of Veterans Affairs, which often negotiates discounts...

In particular, the VA spent $1.7 billion of Gilead's Harvoni hepatitis C treatment in 2016, compared to Medicare Part D, which spent $3 billion on the drug...

Read the article: https://www.beckershospitalreview.com/pharmacy/no-haggle-policy-on-drug-pricing-cost-medicare-at-least-14-4b-study-finds.html

Dr. Luis Balart, who helped develop a cure for hepatitis C, dies at 70

Dr. Luis Balart, who helped develop a cure for hepatitis C, dies at 70

By John Pope, NOLA.com | The Times-Picayune

Dr. Luis A. Balart, a specialist in diseases of the liver who helped develop a cure for hepatitis C, died of leukemia Monday (Jan. 14) in Boston. He was 70.

Dr. Balart, who had lived in New Orleans since 1961, was in Boston for treatment at Dana-Farber Cancer Institute.

During his four-decade career, which included liver transplantation, Dr. Balart was chief of the gastroenterology departments at LSU and Tulane University medical schools, and he worked at Ochsner Medical Center, Southern Baptist Hospital and Tulane Medical Center.

Among his accomplishments was the development of a cure for hepatitis C, a viral affliction that can lead to liver disease, cirrhosis, liver failure and cancer. It is primarily spread through blood-to-blood contact, and about 2.7 million Americans are estimated to suffer from chronic hepatitis C, according to the federal Centers for Disease Control and Prevention.

Continue reading: https://www.nola.com/news/2019/01/dr-luis-balart-who-helped-develop-a-cure-for-hepatitis-c-dies-at-70.html

Study - Vitamin D supplements are of no benefit to those over 70

Study shows vitamin D supplements are of no benefit to the over 70s  
Article ID: 706433
Released: 14-Jan-2019 1:15 PM EST
Source Newsroom: Newcastle University

Newswise — There is little benefit for those over 70 taking higher dose vitamin D supplements to improve their bone strength and reduce the risk of falls, new research has revealed.

Older people are often encouraged to take supplements of vitamin D to keep bones, teeth and muscles healthy.

But a Newcastle University-led study, published in the American Journal of Clinical Nutrition, has backed previous research which shows there is no gain for older people taking vitamin D.

Aim of study
Almost 400 people, aged 70 years or older, were randomly allocated to one of three doses of vitamin D given once a month for a year - the doses were 300 μg, 600 μg or 1200 μg (equivalent to a daily dose of 10 μg, 20 μg or 40 μg).

The study's aim - funded by Versus Arthritis - was to measure in these older people the effect of vitamin D supplementation on the change in bone mineral density (BMD), a recognised indicator of bone strength, and changers in markers of bone metabolism.

The findings revealed that there was no change in BMD over 12 months between the three doses. However, the study did show that doses equivalent to 40 μg a day are safe in an older population and there was a beneficial effect on bone metabolism up to the highest dose.

Dr Terry Aspray, Honorary Clinical Senior Lecturer at Newcastle University's Institute of Cellular Medicine, UK, who is supported by the NIHR Newcastle Biomedical Research Centre, led the Vitamin D supplementation in older people study (VDOP).

He said: "Vitamin D deficiency is common in older people, and it may lead to bone loss, impairment of muscle function and an increased risk of falls and fractures.

"The results from previous studies assessing the effect of vitamin D on bone mineral density have yielded conflicting results, and our study is a significant contribution to the current debate.

"While our findings do not support evidence of the benefit of high dose vitamin D supplements, at least on bone mineral density, we do, however, identify that higher doses of the vitamin may have beneficial effects on bone metabolism and that they are safe for older people.

"I would suggest that older people should focus on maintaining a healthy, balanced diet, adequate sun exposure and take regular exercise to keep their bones as strong as possible.

"While some may need to take vitamin D supplements, there is little benefit to taking more than 10 μg a day."

Further studies

Further analysis is underway, including by a Newcastle University PhD student, on the effects sun exposure on vitamin D levels in older people and the impact of vitamin D supplements on muscle strength.

Experts are also looking at the impact of genes and kidney function on vitamin D levels and their function in the blood.

Benjamin Ellis, Versus Arthritis Senior Clinical Policy Adviser, said: "Older people are at increased risk of falls and fractures, which are debilitating and erode people's self-confidence, depriving them of their independence.

"Vitamin D helps build and maintain strong bones and muscles. People who are deficient in vitamin D are at increased risk of falls and fractures.

"In the summer months, Vitamin D is manufactured by the body when sunlight falls on the skin. We can also get vitamin D from certain foods, or dietary supplements.

"Over the one year of this study, higher doses of vitamin D neither improved measures of bone strength nor reduced falls among older people.

"The current guidance is still that people at risk of low vitamin D should consider taking a daily vitamin D supplement, as should everyone during the winter months.

"Work is needed to implement effective strategies to prevent falls and fractures among older people, and to understand the role of medications and dietary supplements in this."

###
Reference
Randomised controlled trial of vitamin D supplementation in older people (VDOP) to optimise bone health
Terry J Aspray et al
American Journal of Clinical Nutrition. Doi: 10.1093/ajcn/nqy280
SEE ORIGINAL STUDY

A Surgeon Reflects On Death, Life And The 'Incredible Gift' Of Organ Transplant

NPR heard on Fresh Air 

A Surgeon Reflects On Death, Life And The 'Incredible Gift' Of Organ Transplant

Dave Davies 
When Joshua Mezrich was a medical student on the first day of surgical rotation, he was called into the operating room to witness a kidney transplant.

What he saw that day changed him.....

He went on to become a transplant surgeon and has since performed hundreds of kidney, liver and pancreas transplants. He also has assisted in operations involving other organs.

Each organ responds to transplant in a different way.

"The liver will start pouring bile. The lungs start essentially breathing," Mezrich says. "Maybe the most dramatic organ, of course, is the heart, because you put it in and you kind of hit it like you hit a computer, maybe you give a little shock and it just starts beating, and that's pretty darn dramatic."

Read the article, here …..

Americans have greater chance of dying of an accidental opioid overdose than in a car crash

For the First Time, We're More Likely to Die From Accidental Opioid Overdose Than Motor Vehicle Crash - 

A person is more likely to die from an accidental opioid overdose than from a motor vehicle crash, according to the National Safety Council analysis, per a report labeled "Injury Facts"

ITASCA, Ill., Jan. 14, 2019 /PRNewswire/ -- For the first time in U.S. history, a person is more likely to die from an accidental opioid overdose than from a motor vehicle crash, according to National Safety Council analysis. The odds of dying accidentally from an opioid overdose have risen to one in 96, eclipsing the odds of dying in a motor vehicle crash (one in 103). The National Safety Council unveiled the analysis on Injury Facts – the definitive resource for data around unintentional, preventable injuries – commonly known as "accidents." The nation's opioid crisis is fueling the Council's grim probabilities, and that crisis is worsening with an influx of illicit fentanyl.

"We've made significant strides in overall longevity in the United States, but we are dying from things typically called accidents at rates we haven't seen in half a century," said Ken Kolosh, manager of statistics at the National Safety Council. "We cannot be complacent about 466 lives lost every day. This new analysis reinforces that we must consistently prioritize safety at work, at home and on the road to prevent these dire outcomes."

NSC analysis also shows that falls – the third leading cause of preventable death behind drug overdose and motor vehicle crashes – are more likely to kill someone than ever before. The lifetime odds of dying from an accidental fall are one in 114 – a change from one in 119 just a year ago.

To keep the public up to date on the latest injury and fatality trends, the Council has added "Poisonings," "Older Adult Falls," "Fire-Related Fatalities and Injuries," and "Deaths by Transportation Mode" to Injury Facts. To demonstrate why Americans should be more concerned about preventable injuries than headline-grabbing catastrophes, the Council also added designated pages about airplane crashes, railroad deaths and consumer products – all issues that tend to spark nationwide anxiety but lead to far fewer fatal incidents than routine, everyday activities such as taking medication, driving or getting out of bed.

Preventable injuries are the third leading cause of death, claiming an unprecedented 169,936 lives in 2017 and trailing only heart disease and cancer. Of the three leading causes of death, preventable injuries were the only category to experience an increase in 2017, according to NSC analysis of the CDC data issued in December. A person's lifetime odds of dying from any preventable, accidental cause are one in 25 – a change from one in 30 in 2004.

https://www.prnewswire.com/news-releases/for-the-first-time-were-more-likely-to-die-from-accidental-opioid-overdose-than-motor-vehicle-crash-300777184.html

HCV requires serious policies and affordable insurance coverage

Of Interest
Q&A: DAA restrictions impact patient care
January 14, 2019

Infectious Disease News spoke with Breskin about why DAAs restrictions were enacted, the current state of treatment denials and how DAA policies should be changed.

Beyond interferon side effects: What residual barriers exist to DAA hepatitis C treatment for people who inject drugs? 

The paper draws on participant interview data from a qualitative research study based on a participatory research design that included a peer researcher with direct experience of both hepatitis C DAA treatment and injecting drug use at all stages of the research process.

The role of insurance providers in supporting treatment and management of hepatitis C patients

Masoud Behzadifar, Hasan Abolghasem Gorji, Aziz Rezapour, Meysam Behzadifar and Nicola Luigi Bragazzi

BMC Health Services Research201919:25
https://doi.org/10.1186/s12913-019-3869-8

Excerpt from the article:
In order to cope with the high costs of the new DAA regimens, some insurers are restricting access to medications, establishing selective criteria for reimbursement. Gowda and collaborators performed a prospective cohort study among American HCV patients (Open Access Published online 2018 Jun 7). Authors found that absolute denials of DAA regimens by insurers have remained high and increased over time.

Received: 24 April 2018
Accepted: 4 January 2019

Published: 10 January 2019

Full-text article
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The role of insurance providers in supporting treatment and management of hepatitis C patients
Abstract
Today, one of the most important global public health challenges is represented by hepatitis C virus (HCV), which imposes relevant costs. Globally speaking, the median cost of HCV-related complications ranges from $280 for an uncomplicated hepatitis to $139,070 for a liver transplantation. There are effective therapies for HCV patients worldwide, which has increased the hope of improving the process of managing and curing these patients. The adherence of patients to the pharmacological treatment and the use of effective drugs in the management of HCV disease are of crucial importance for health policy- and decision-makers. Studies show that, globally, insurance coverage for patients with HCV is not adequate in that still many patients are not covered by insurance programs. This issue as well as the economic conditions of countries are very serious challenges for ensuring an effective treatment. The most important and greatest help currently available to ensure HCV treatment is to implement plans to reduce costs and support patients. Some studies have shown that the expansion of coverage by private payers seems able to generate positive spillover benefits to public insures. Insurers, in addition to maintaining and increasing their own interests, are trying to increase their social status as a sponsor of patients. In conclusion, HCV disease requires serious policies and affordable insurance coverage.

Read the full article: 

https://bmchealthservres.biomedcentral.com/articles/10.1186/s12913-019-3869-8

On This Blog
Controversy over the cost of hepatitis C drugs
Link to research and news articles addressing insurance restrictions; private insurers/Medicaid - and -availability of generic versions of hepatitis C medications. 

Three-part series: What’s the Difference: Hepatitis B vs Hepatitis C?

Hepatitis B Foundation

With five different types of viral hepatitis, it can be difficult to understand the differences between them. Some forms of hepatitis get more attention than others, but it is still important to know how they are transmitted, what they do, and the steps that you can take to protect yourself and your liver!

This is part one in a three-part series. 

Begin here...…...