Washington state hepatitis C partnership

For hepatitis C, seeking the end of the road in Washington state

With hepatitis C on the rise from coast to coast, a new partnership model aims to help eliminate a serious infectious disease.

Published September 23, 2019 / All Stories

Destination elimination

Despite decades of work and hundreds of millions of dollars spent, eliminating hepatitis C in the United States remains a frustratingly elusive goal. And as the number of new hepatitis C virus (HCV) infections spikes in young Americans,1 the consequences of failing to stop this infectious disease in the U.S. looms large. In fact, according to the U.S. Centers for Disease Control and Prevention (CDC), in 2012 the number of deaths associated with hepatitis C surpassed that of 60 other nationally notifiable infectious conditions that are routinely reported to the CDC.2

Now, AbbVie and the Washington State Health Care Authority (HCA) are embarking on an ambitious mission with the shared goal of eliminating* HCV within an entire U.S. state.3 This new public-private model aims to solve a public health paradox that isn’t unique to HCV: the stubborn, persistent challenge of physically locating and helping the most patients in need in the shortest amount of time. For these new partners, overcoming that challenge for thousands of people living with HCV means a unique mix of data technology, innovation and old-fashioned boots-on-the-ground.

“Washington has a clear vision and admirable goals for eliminating hepatitis C, and they’re making an enormous amount of progress on that commitment,” says Michael Staff, vice president of U.S. market access for AbbVie. “But hepatitis C is a public health problem that’s just too big and complex to go it alone.”

Chronic, untreated infections may progress to liver failure, liver cancer or even death. Fortunately, HCV can be cured. Unfortunately, a bewildering array of roadblocks obstruct the path to a cure, including stigma, low public awareness, lack of commitment, and little understanding about how easily patients can slip through the cracks of even the most comprehensive health care system.

Navigating speedbumps ahead

The HCA is responsible for purchasing the health care for approximately 25,000 hepatitis C patients who are covered by the federal Medicaid healthcare program, according to Judy Zerzan, M.D., chief medical officer for HCA. Despite a budget of $80 million in 2018, only 12 percent of all eligible Medicaid hepatitis C patients — 3,000 patients in total — were treated. Even with a generous budget to fight such a deadly disease, progress can be evasive.

“There are barriers along every single step of this journey,” said Nancy Reau, M.D., professor of medicine and chief of the hepatology division at Rush University Medical Center in Chicago. “One of the biggest hurdles is simply finding patients—people who don’t know that they’re at risk or that their disease can be cured. If we can’t find them, we can’t eliminate the virus, which means more serious—and more costly—consequences for patients and healthcare systems in the long run.”

Total number of patients in 2016 with a positive HCV RNA test recorded during 2013–2016, derived from two large de-identified US laboratory datasets. Source: https://mappinghepc.com/methods-and-limitations

Washington state public health officials faced one hurdle after another when it came to locating patients, matching them to a treatment, keeping them in care throughout the duration of a several weeks-long treatment program, and providing follow up health care services. So began the hunt for an ally who shared the state’s vision for HCV elimination and had the experience and capabilities to provide meaningful, coordinated support, explained Zerzan.

“We were looking for a partnership because we really want to break through these barriers,” Dr. Zerzan says. “It’s not just about the price of a treatment; we need help across the entire spectrum of care, including finding cases, educating patients and providers, getting people into treatment, and helping them stay there. That’s why we’re really excited by the experience and support that AbbVie brings to the table.”

The partnership is a modified subscription-type plan that helps Washington State control costs while also increasing the potential to care for HCV patients. 3 The partnership is projected to substantially increase the number of HCA Medicaid patients that Washington state would have been able to treat on its own, and reduce the state’s spend for hepatitis C care of its Medicaid population.

Beyond the disease itself, Zerzan ultimately envisions that Washington could see long-term health care savings in the form of fewer costly medical procedures for patients with advanced disease, such as liver transplants, along with societal benefits such as HCV risk reduction due to the reduced spread of HCV infections.

Boots on the ground

Washington HCA and AbbVie know that medicine is only half the battle. To that end, they are mobilizing on the ground to break down barriers to care in towns and cities where HCV is most prevalent.

A hepatitis C elimination awareness bus will soon travel across the state as part of a broader, national approach AbbVie has successfully used in the past to reach people with information on HCV. While a bus may sound low-tech, its destinations are informed by data that can help pinpoint the locales where HCV infections are most common.

The bus is a rolling reminder of the power of HCV education—bringing disease awareness to familiar places for people who may be uncomfortable stepping foot inside traditional medical facilities.
“The hepatitis C elimination awareness bus is one of the things that I’m personally most excited about,” Dr. Zerzan says.
Dr. Zerzan is also excited for the possibilities coming from AbbVie’s data approach in helping the state find “missing” hepatitis C patients—those who are undiagnosed—through outreach to physicians in areas of high disease density and targeted educational and awareness advertising in these areas.
Another area of focus is on substance abuse treatment centers. AbbVie will coordinate with HCA on HCV elimination efforts so that people who inject drugs and test positive for HCV have the resources they need to get connected to care.
“We feel like people who inject drugs or are caught up in the opioid problem are the most vulnerable and at risk of spreading HCV, so we don’t want to put any obstacles on their path to getting care,” Dr. Zerzan says.

Go big or go home

Dr. Zerzan is confident that this new model will make a difference. Dr. Zerzan believes the state will now be able to find and treat substantially more of its Medicaid patients per year thanks to this partnership with AbbVie, as both organizations work in parallel toward meeting the World Health Organization goal of eliminating hepatitis C globally by 2030.5

“If not now, then when?” says Zerzan. “We feel like now’s the time to go bold and go do it.”

Hepatitis C can be considered cured when the virus is not detectable in the blood 12 weeks after appropriate treatment is completed.

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Name: Raquel Powers
Email: raquel.powers@abbvie.com
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