Reply to: “Treatment of veterans with hepatitis C in the United States Department of Veterans Affairs”
Authors: Bennet Cecil
Journal: Journal of Hepatology (2013)

Why 88% of US military veterans with HCV are not treatedJournal of HepatologyVol. 57Issue 4PreviewThe article in the February issue of the Journal of Hepatology reported that less than 12% of American military veterans identified with HCV were treated with antiviral therapy [1]. The Veterans Administration does not want to spend adequate funds to cure patients with hepatitis C. Dr. Kenneth Kizer, Under Secretary for Health in the US Department of Veterans Affairs (VA), gave HCV a high priority but unfortunately he left the VA in 1999. Subsequent leadership has not shown enthusiasm for treating HCV. Full-Text PDF Open AccessTreatment of veterans with hepatitis C in the United States Department of Veterans AffairsJournal of HepatologyVol. 59Issue 1PreviewAs Director of the National Hepatitis C Program for the United States Department of Veterans Affairs [VA], the largest provider of care in the United States for HCV, I would like to respond to the statements by Dr. Bennett Cecil in the October 2012 issue of the Journal of Hepatology about access to and quality of care for HCV-infected Veterans in VA care [1]. Full-Text PDF Open Access I would like to thank Dr. Ross.(1)Dr. Ross does not state how many veterans with HCV are currently receiving care at the Department of Veterans Affairs (VA). In 2008, VHA clinicians cared for over 147,000 veterans with chronic HCV [[1]http://www.hepatitis.va.gov/provider/policy/HCV-state-of-care-2010.asp.Google Scholar]. Treating 4500 patients with HCV in 20 months is only 225 patients per month. The VA is currently treating less than 2% of infected veterans per year with boceprevir and telaprevir. It will take more than fifty years for the VA to treat all of their HCV infected patients. Evidence based care of an infectious disease is cure of the infection not the development of integrated models to address comorbidities. If 98% of patients with a curable infection are not treated each year, the VA’s response is inadequate.(2)The VA does a better job with the human immunodeficiency virus (HIV) treating 78% of veterans [[2]http://www.va.gov/opa/publications/factsheets/fs_hiv_aids_treatment.pdf.Google Scholar]. The number of patients on antiviral therapy clearly indicates that HIV is a high priority for the VA while HCV treatment is not.(3)Telaprevir is not available as a non-formulary drug at the Louisville VA. Boceprevir is on the formulary there.(4)More than 1800 patients with HCV antibodies have been identified at the Louisville VA over 19 years. They had multiple physicians providing care.(5)$100 million for antiviral therapy over 20 months is $5 million per month. This is clearly inadequate to treat 147,000 veterans with hepatitis C. This is why legislation should be passed so that all veterans with HCV immediately prequalify for their choice of Medicaid or Medicare. They could then obtain antiviral therapy in the private sector instead of waiting for the VA to treat 2% of them each year. Now, many are trapped in the VA system while their curable infection progresses to liver cancer, liver failure and death. The author declared that he does not have anything to disclose regarding funding or conflict of interest with respect to this manuscript.