2012 Viral Hepatitis Conference Reveals HCV Testing Guidelines For Hepatitis C Are Not Being Followed By Either Insurance Companies Or Medical Providers

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.

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.

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?"

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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