Dr. Michael Horberg is Executive Director Research, Community Benefit and Medicaid Strategy of the Mid-Atlantic Permanente Medical Group (MAPMG) and the director of the Mid-Atlantic Permanente Research Institute (MAPRI). Carla Rodriguez , PhD, MPH, and Cabell Jonas, PhD also contributed to this post.
Too often, news coverage of hepatitis C focuses on the cost of new drugs and not the importance of determining which patients have hepatitis C and getting them into effective care.
An estimated 50 percent to 80 percent of those with hepatitis C are unaware of their infection. Experts believe that is a group of some 800,000 people. Screening them all could prevent 120,000 deaths – not to mention stop the spread of infection to others. Simple blood testing and liver damage assessment, seems like a low price to save 120,000 lives – or thought of differently, preventing a deadly plane crash every day for the next year.
It is well known across medicine who should be screened (everyone born between 1945 and 1965, plus at-risk individuals such as those with HIV or patients on kidney dialysis, men who have sex with men, and people who have used injectable drugs now or in the past). But we at the Mid-Atlantic Permanente Research Institute (MAPRI), the institutional research arm of Kaiser Permanente of the Mid-Atlantic States and the Mid-Atlantic Permanente Medical Group (MAPMG), set out to find a way to actually make it happen. Data suggests only a few percent get screened (0.7-12.7 percent) – and less than half of those end up actually linked to care they need. If others could adopt our innovative program, the impact could be tremendous.
Knowing the problem is half the battle. We found that most doctors have a hard time remembering when to recommend their patient be screened. And, for those doctors who order the screening, patients may still not follow through because they need to complete three discrete steps (an antibody blood test, an RNA blood test, and liver imaging or biopsy). Therefore, our solution carefully addressed each problem. The solution:
- Automated alert when doctors open charts during visits with patients who match screening criteria
- The antibody blood test is linked to an order for the confirmatory HCV RNA test (meaning blood is collected at a single visit to the lab rather than asking the patient back for a second blood draw for the HCV RNA test)
- Provided for a dedicated coordinator who could make sure no one fell through the cracks and helped them get the liver damage testing they may need contingent upon blood test results as well as linkage to ongoing care from their physician or a specialist
- Offered patients a non-invasive, pain free liver damage assessment rather than a biopsy (when clinically feasible)
New peer-reviewed research shows that the integrated screening approach is working. Screenings are up dramatically, those who start step one of screening are getting a complete diagnosis and linkage to care
While the cost of treating hepatitis C is no doubt an important issue, we also need to pay attention to and champion screening advances that will help us do a better job of diagnosing and stopping the spread of this deadly virus.