National Viral Hepatitis Roundtable
Public Policy Position Process

From National Hepatitis C Advocacy Council

1) Issue

a) Background:

i) U.S. Preventive Services Task Force, an independent expert panel supported by the Agency for Healthcare Research and Quality, wrote in the March 2004 issue of the Annals of Internal Medicine that it found no scientific evidence to show that high-risk adults receive any long-term benefit from hepatitis C screening such as improved quality of life or years of life gained. Therefore, the Task Force reasoned that they could neither recommend for nor against hepatitis C screening among high-risk adults.

ii) According to the report, "Screening makes sense only if the benefits of treating HCV infection before symptoms develop are greater than the potential harms." The harms cited were the side effects, inconvenience, and costs of treatment. The report also claims that patients might suffer "anxiety" and "labeling" as a result of being screened and learning about their hepatitis C infection.

iii) Because there are no hepatitis C specific studies to show that patients who do become aware of their status actually make changes to their lifestyle, there was no way to prove that the benefits of screening outweighed the potential harms.

b) Concerns:

i) NHCAC members fear that existing CDC and NIH recommendations to screen high-risk adults will be undermined by this report, leaving the country's most vulnerable patients without proper care and counseling.

ii) Additionally, there is potential for widespread support for the new guidelines, especially among those who want to (continue) do little in response to the hepatitis C epidemic.

iii) Finally, AHRQ guidelines have been used in courts and by insurers as de-facto medical community standards-of-care.

c) These guidelines pose a direct threat to the health and well-being of all people affected by hepatitis C, and will surely undermine the progress made to date.

2) Proposed Action:

a) NVHR requests a hearing in the Senate
b) Key points:

i) Physicians and patients should be able to rely on a consistent message from the federal government. It should be made clear by Health and Human Services that the existing CDC and NIH recommendations have not been replaced.

ii) Screening for hepatitis C is a vital component of an effective national hepatitis C strategy, which ensures delivering patients the highest standard of care, as well as preventing future transmissions.

iii) The absence of study data does not equate to a lack of benefit from screening. It simply means that direct funding is needed to study these crucial issues.

iv) There are an abundant data available for similar diseases that strongly support the benefits of early detection.

3) Likely to Support the USPSTF Guideline

a) USPSTF team and AHRQ
b) Correctional Health Services (Jails/Prisons)
c) CMS / Insurers / Managed Care / Medicaid

4) Likely to Support Reversing the USPSTF Guideline

a) Affected populations
b) HIV/AIDS agencies
c) Legislators
d) CDC
e) NIH
f) AASLD; AGA

NVHR Policy Statement

The National Viral Hepatitis Roundtable is a public-private coalition composed of 114 member organizations representing the needs of those at risk for viral hepatitis (A, B and C) as well as those with viral hepatitis . The goal of the roundtable is to eliminate viral hepatitis in the United States, and to that end, it is currently developing a comprehensive plan to address hepatitis research, screening and prevention, education, care and treatment needs for the entire nation. In the meantime, the NVHR views a Senate hearing on the U.S Preventive Services Task Force as an important opportunity to inform you of our concerns that the USPSTF recommendations create confusion in the medical and patient communities and will result in increased morbidity and mortality. Furthermore, the NVHR recommends that the Secretary of HHS strongly reiterate the CDC and NIH screening recommendations for hepatitis C. These recommendations serve the dual purpose of identifying those in need of treatment for hepatitis C, while also providing those infected with advice and assistance to prevent transmission of their infections.