A new report of an in-depth study involving more than 30
million medical claims from both a commercial insurance provider and from
Medicare suggest that current recommendations for hepatitis C virus (HCV)
testing are not being followed. In fact, not only are they not being followed –
they are being egregiously ignored. What is astonishing in the findings is that
the adult demographic with the lowest incidence of HCV infection — young women
— is the most likely to be tested. These results are according to data
presented at the 2012 International Conference on Viral Hepatitis.
Once again, I have to express incredible frustration about
the incompetence being shown in regards to HCV testing in the United States,
With over 2 million Americans unaware that they have been infected for time
periods that range anywhere from yesterday to fifty years ago, an effective
awareness campaign directed at both the insurance companies and the consumer
has become a necessity. It is no longer a choice with more Americans dying from
HCV as oppsed to HIV since 2002.
It is not only the doctors and the consumers getting involved in the outcry. With countless millions invested, the Pharmaceutical giants are on the bandwagon as well. "The CDC is looking at changing the HCV guidelines to mandate a 1-time HCV antibody test for everybody born between 1945 and 1965," said lead analyst Camilla Graham, MD, who is vice president of global medical affairs for Vertex Pharmaceuticals.
Recent studies have suggested that the 1945 to 1967 birth cohort accounts for 81% of all people diagnosed with HCV infection. "This study was done to look at who is actually getting tested for HCV in the United States under current risk-based screening recommendations." The analysis was performed using records from the Thomson Medstat MarketScan commercial database, a resource comprising medical and outpatient pharmacy claims from employer-sponsored health insurance plans and including more than 30 million commercially insured and 3 million Medicare supplemental-insured individuals.
It is not only the doctors and the consumers getting involved in the outcry. With countless millions invested, the Pharmaceutical giants are on the bandwagon as well. "The CDC is looking at changing the HCV guidelines to mandate a 1-time HCV antibody test for everybody born between 1945 and 1965," said lead analyst Camilla Graham, MD, who is vice president of global medical affairs for Vertex Pharmaceuticals.
Recent studies have suggested that the 1945 to 1967 birth cohort accounts for 81% of all people diagnosed with HCV infection. "This study was done to look at who is actually getting tested for HCV in the United States under current risk-based screening recommendations." The analysis was performed using records from the Thomson Medstat MarketScan commercial database, a resource comprising medical and outpatient pharmacy claims from employer-sponsored health insurance plans and including more than 30 million commercially insured and 3 million Medicare supplemental-insured individuals.
Making sure the results were accurate, the study used only claims
made from 2004 to 2008 that have been verified. People who had undergone HCV
testing were identified on the basis of Current Procedural Technology codes for
HCV antibody or HCV RNA testing, birth cohort, and sex. People diagnosed with
HCV infection after testing were identified with International
Classification of Diseases, Ninth Revision (ICD-9) codes.
"Filters were also employed to find people newly identified with HCV as of
2008," said Dr. Graham, "to get a sense of diagnosis trends."
For 2008, only 1.1% of individuals in the payer population and 1.7% in the Medicare population had been tested for HCV. "This is actually an increase from 2004, and a maximum for the study period," Dr. Graham noted. By far, more women than men are being tested. Since data continuing to accrue show that men have higher exposure to HCV and a greater likelihood of having chronic HCV infection, why are women being tested more frequently? Of the currently identified 800,000 HCV-related cases of cirrhosis in the United States, 75% are men.
For 2008, only 1.1% of individuals in the payer population and 1.7% in the Medicare population had been tested for HCV. "This is actually an increase from 2004, and a maximum for the study period," Dr. Graham noted. By far, more women than men are being tested. Since data continuing to accrue show that men have higher exposure to HCV and a greater likelihood of having chronic HCV infection, why are women being tested more frequently? Of the currently identified 800,000 HCV-related cases of cirrhosis in the United States, 75% are men.
In addition, only 32.8% of people born from 1945 to 1964
have been tested, even though this cohort has the highest rate of infection. In
contrast, 48.2% of people born from 1970 to 1989 have been tested, although
their rate of HCV infection is known to be much lower. An analysis of HCV
diagnosis during the study period illustrates a displaced diligence in HCV
screening. "When we look at the people who were actually diagnosed, young
women have a much lower prevalence than older men." The results of this
study are both disturbing and strange because they do not make sense. Why do
the tested populations differ so dramatically from what we know about
populations at risk and the multitude of risk factors, including age and
gender?
For the birth period of 1945 to 1954, 3.5% of women and 7.4% of men were diagnosed with HCV. For 1955 to 1964, 2.9% of women and 5.7% of men were diagnosed with HCV. Medicare data show that 16.1% of men and 10.4% of women in the 1945 to 1954 cohort and 19.1% of men and 13.3% of women in the 1955 to 1974 cohort are HCV-positive. Dr. Graham expressed both her analysis and surprise in her comments: "Medicare is a more complicated population," because some patients are enrolled on the basis of disability rather than age. But again, you see a shockingly high prevalence of HCV in men. Is Medicare aware of this serious HCV problem as the leading edge of the boomers are entering the program?"
For the birth period of 1945 to 1954, 3.5% of women and 7.4% of men were diagnosed with HCV. For 1955 to 1964, 2.9% of women and 5.7% of men were diagnosed with HCV. Medicare data show that 16.1% of men and 10.4% of women in the 1945 to 1954 cohort and 19.1% of men and 13.3% of women in the 1955 to 1974 cohort are HCV-positive. Dr. Graham expressed both her analysis and surprise in her comments: "Medicare is a more complicated population," because some patients are enrolled on the basis of disability rather than age. But again, you see a shockingly high prevalence of HCV in men. Is Medicare aware of this serious HCV problem as the leading edge of the boomers are entering the program?"
Why are so many young women being tested? The most likely
answer is prenatal testing because of pregnancy rates. The truth is not that
the medical community is so concerned that young women have HCV, but that they
are simply following medical procedures that have been instituted as
safeguards. Without question, HCV awareness and testing is on the back burner
of health issues. How many people have to die unnecessarily before this
changes?
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