WASHINGTON — Too many Americans are missing out on a cure for hepatitis C, and a study underway in a hard-hit corner of Kentucky is exploring a simple way to start changing that.
The key: On-the-spot diagnosis to replace today’s multiple-step testing.
In about an hour and with just a finger-prick of blood, researchers can tell some of the toughest-to-treat patients — people who inject drugs — they have hepatitis C and hand over potentially life-saving medication.
Timothy D. Easley, Associated Press
Ashley Holliday, senior medical assistant, prepares tests for hepatitis C and HIV on Dec. 12 in Hazard, Ky.
Waiting for standard tests “even one or two days for someone who’s actively using drugs, we can lose touch with them,” said Jennifer Havens of the University of Kentucky, who’s leading the study in rural Perry County. To start treatment right away “that’s huge, absolutely huge.”
Single-visit hepatitis C diagnosis already is offered in other countries, and now the White House wants to make it a priority here.
“It’s frankly an embarrassment” that the U.S. doesn’t have such an option, said Jeffrey Weiss of New York’s Mount Sinai health system, who works with a community hepatitis C outreach program. “We have many people we’ve tested and want to give their results to and can’t find them.”
At least 2.4 million Americans are estimated to have hepatitis C, a virus that silently attacks the liver, leading to cancer or the need for an organ transplant. It leads to more than 14,000 deaths a year. That’s even though a daily pill taken for two to three months could cure nearly everyone with few side effects.
Yet in the U.S., more than 40% of people with hepatitis C don’t know they’re infected. Fewer than 1 in 3 insured patients who are diagnosed go on to get timely treatment. And new infections are surging among younger adults who share drug needles.
“This is a travesty,” said Dr. Francis Collins, the former National Institutes of Health director who’s now a White House adviser devising a new national strategy to tackle hepatitis C.
Most likely to fall through the cracks are “people in tough times” — those who inject drugs, are uninsured or on Medicaid, or are homeless or incarcerated — who can’t navigate what Collins calls the “clunky” diagnosis process and other barriers to the pricey pills.
For the country not to address those inequities “feels like a moral failing,” Collins told The Associated Press.
All American adults are urged to be screened for hepatitis C, a blood test that simply tells if someone’s been exposed. Because the immune system sometimes clears the virus, anyone found positive then must get a different kind of blood test to confirm they’re still infected. If so, they return again to be prescribed treatment.
But in Britain, Australia and parts of Europe, people can get on-the-spot hepatitis C diagnostic testing, using a machine made by California-based Cepheid Inc. It’s sort of a lab-in-a-box that’s especially useful for mobile clinics and needle-exchange programs where hard-to-reach populations can be tested and start treatment in a single visit.
This kind of technology isn’t new — Cepheid’s version already is used in the U.S. to do quick tests for COVID-19, flu and certain bacterial infections, among other things. But test manufacturers haven’t gone through the complex U.S. regulatory process for approval to diagnose hepatitis C.
Timothy D. Easley, Associated Press
Ashley Holliday, senior medical assistant, loads a sample to test for hepatitis C and HIV on Dec. 12 in Hazard, Ky.
Chief scientific officer David Persing said Cepheid hopes to take that step next year — using a new pandemic-era program that would streamline the evidence needed for clearance of an easy-access, test-and-treat option.
Testing isn’t the only hurdle. A full course of hepatitis C pills costs about $24,000, much less than when they first hit the market but enough that many states still restrict which Medicaid patients are treated. Some require proof of sobriety to get care, stalling efforts to stop current spread of the virus among people who inject drugs. Others add red-tape “prior authorization” requirements and some order consultations with liver specialists, according to the National Viral Hepatitis Roundtable and Harvard researchers.
Pilot programs have attempted to overcome such barriers. For example, Louisiana negotiated a yearly flat-fee for unlimited doses of hepatitis C medication for Medicaid patients and state prisoners. It got off to a strong start but was interrupted by the COVID-19 pandemic and hasn’t recovered: Louisiana has treated about 12,600 such patients since 2019, out of an estimated 40,000 in need.
The scope of Collins’ plans for a national hepatitis program will depend on how much money the Biden administration comes up with — but faster, easier testing is a priority.
In Perry County, Kentucky, Havens’ team uses the Cepheid test in an NIH-funded study on how to improve care for hepatitis C patients struggling with addiction. While potential study participants await their test results, researchers teach them about the virus and offer other health services.
“Even if they test negative, they still got something” useful from the visit, Havens said.
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US grapples with ‘travesty’ of untreated hepatitis C
Monkey Business Images
Photo Credit: Monkey Business Images / Shutterstock
The challenges facing the healthcare sector in the U.S. are numerous. The U.S. lags behind other developed nations on many key metrics of health, including life expectancy, chronic disease burden, and avoidable deaths. The population has been growing older on average with the aging of the Baby Boomers, creating increased demand for health services. Longtime public health challenges like obesity, substance abuse, and mental illness have wide-ranging impacts on Americans’ overall health and well-being. And in the last few years, the COVID-19 pandemic has placed unusually heavy strain on healthcare providers and hospitals.
With these many interlocking and compounding challenges, the U.S. spends heavily to support the healthcare system. According to federal data, national health expenditures in the U.S. total $4.1 trillion per year, making up nearly 20% of the nation’s GDP. The bulk of this spending comes from the federal government, which contributes 36.3% of expenditures, and U.S. households, which account for 26.1%.
Often underappreciated in discussions of the U.S. health system is the role of state and local governments. States and localities frequently fund public hospitals, health inspections, mental health and substance abuse programs, water and air quality programs, and payments to private hospitals for public health services. State and local governments funded 14.3% of total national health expenditures in 2020.
Monkey Business Images
Photo Credit: Monkey Business Images / Shutterstock
The challenges facing the healthcare sector in the U.S. are numerous. The U.S. lags behind other developed nations on many key metrics of health, including life expectancy, chronic disease burden, and avoidable deaths. The population has been growing older on average with the aging of the Baby Boomers, creating increased demand for health services. Longtime public health challenges like obesity, substance abuse, and mental illness have wide-ranging impacts on Americans’ overall health and well-being. And in the last few years, the COVID-19 pandemic has placed unusually heavy strain on healthcare providers and hospitals.
With these many interlocking and compounding challenges, the U.S. spends heavily to support the healthcare system. According to federal data, national health expenditures in the U.S. total $4.1 trillion per year, making up nearly 20% of the nation’s GDP. The bulk of this spending comes from the federal government, which contributes 36.3% of expenditures, and U.S. households, which account for 26.1%.
Often underappreciated in discussions of the U.S. health system is the role of state and local governments. States and localities frequently fund public hospitals, health inspections, mental health and substance abuse programs, water and air quality programs, and payments to private hospitals for public health services. State and local governments funded 14.3% of total national health expenditures in 2020.
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US grapples with ‘travesty’ of untreated hepatitis C
This spending is one of the most significant budgetary responsibilities of state and local governments. Health and hospitals represent the third largest spending category for state and local governments, behind only public welfare and elementary and secondary education. Collectively, governments spend $345 billion on health and hospitals each year, accounting for nearly 10% of all state and local spending.
This spending is one of the most significant budgetary responsibilities of state and local governments. Health and hospitals represent the third largest spending category for state and local governments, behind only public welfare and elementary and secondary education. Collectively, governments spend $345 billion on health and hospitals each year, accounting for nearly 10% of all state and local spending.
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US grapples with ‘travesty’ of untreated hepatitis C
State and local spending on health and hospitals on a per-capita basis has also grown over time. In the year 2000, state and local governments spent $678 per capita on health and hospitals in inflation-adjusted dollars. By 2020, that figure had risen to $1,040—an increase of more than 50%.
State and local spending on health and hospitals on a per-capita basis has also grown over time. In the year 2000, state and local governments spent $678 per capita on health and hospitals in inflation-adjusted dollars. By 2020, that figure had risen to $1,040—an increase of more than 50%.
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US grapples with ‘travesty’ of untreated hepatitis C
However, this trend has not played out the same in all locations. In fact, 13 states have seen a decline in health and hospital spending per capita over the last decade, led by Arizona, where spending has declined by more than 50%. In contrast, other states have seen rapid growth in health spending. Vermont’s inflation-adjusted state and local spending per capita more than doubled between 2010 and 2020, from $355 to $730, and Utah’s 96.2% rate of growth was not far behind.
Just as trends in health spending have varied by geography, total spending also looks different from state to state. Nationwide, states and localities spend around 9.9% of their budgets on health and hospitals, at a total of $1,047 per capita. But a number of states and localities spend well above these figures, including Wyoming, where the per-capita spending is nearly triple the national average, and South Carolina, where health and hospital spending represents nearly 20% of state and local expenditures.
The data used in this analysis is from the U.S. Census Bureau. To determine the states that spend the most on health and hospitals, researchers at HowtoHome.com calculated health and hospital spending as a share of total spending. In the event of a tie, the state with the greater total health and hospital spending per capita was ranked higher.
Here are the states that spend the most on health and hospitals.
However, this trend has not played out the same in all locations. In fact, 13 states have seen a decline in health and hospital spending per capita over the last decade, led by Arizona, where spending has declined by more than 50%. In contrast, other states have seen rapid growth in health spending. Vermont’s inflation-adjusted state and local spending per capita more than doubled between 2010 and 2020, from $355 to $730, and Utah’s 96.2% rate of growth was not far behind.
Just as trends in health spending have varied by geography, total spending also looks different from state to state. Nationwide, states and localities spend around 9.9% of their budgets on health and hospitals, at a total of $1,047 per capita. But a number of states and localities spend well above these figures, including Wyoming, where the per-capita spending is nearly triple the national average, and South Carolina, where health and hospital spending represents nearly 20% of state and local expenditures.
The data used in this analysis is from the U.S. Census Bureau. To determine the states that spend the most on health and hospitals, researchers at HowtoHome.com calculated health and hospital spending as a share of total spending. In the event of a tie, the state with the greater total health and hospital spending per capita was ranked higher.
Here are the states that spend the most on health and hospitals.
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US grapples with ‘travesty’ of untreated hepatitis C
Shutterstock
Photo Credit: Agnieszka Gaul / Shutterstock
- Health & hospital spending as a share of total: 10.7%
- Total health & hospital spending per capita: $999
- Total health & hospital spending: $6,747,518,000
- Total direct expenditures: $62,806,487,000
Shutterstock
Photo Credit: Agnieszka Gaul / Shutterstock
- Health & hospital spending as a share of total: 10.7%
- Total health & hospital spending per capita: $999
- Total health & hospital spending: $6,747,518,000
- Total direct expenditures: $62,806,487,000
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US grapples with ‘travesty’ of untreated hepatitis C
Shutterstock
Photo Credit: Sean Pavone / Shutterstock
- Health & hospital spending as a share of total: 10.7%
- Total health & hospital spending per capita: $1,061
- Total health & hospital spending: $9,112,433,000
- Total direct expenditures: $85,243,956,000
Shutterstock
Photo Credit: Sean Pavone / Shutterstock
- Health & hospital spending as a share of total: 10.7%
- Total health & hospital spending per capita: $1,061
- Total health & hospital spending: $9,112,433,000
- Total direct expenditures: $85,243,956,000
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US grapples with ‘travesty’ of untreated hepatitis C
Shutterstock
Photo Credit: Photosbykaity / Shutterstock
- Health & hospital spending as a share of total: 11.2%
- Total health & hospital spending per capita: $1,078
- Total health & hospital spending: $10,748,283,000
- Total direct expenditures: $95,700,844,000
Shutterstock
Photo Credit: Photosbykaity / Shutterstock
- Health & hospital spending as a share of total: 11.2%
- Total health & hospital spending per capita: $1,078
- Total health & hospital spending: $10,748,283,000
- Total direct expenditures: $95,700,844,000
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US grapples with ‘travesty’ of untreated hepatitis C
Shutterstock
Photo Credit: Roschetzky Photography / Shutterstock
- Health & hospital spending as a share of total: 11.3%
- Total health & hospital spending per capita: $1,013
- Total health & hospital spending: $29,753,376,000
- Total direct expenditures: $263,279,685,000
Shutterstock
Photo Credit: Roschetzky Photography / Shutterstock
- Health & hospital spending as a share of total: 11.3%
- Total health & hospital spending per capita: $1,013
- Total health & hospital spending: $29,753,376,000
- Total direct expenditures: $263,279,685,000
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US grapples with ‘travesty’ of untreated hepatitis C
Shutterstock
Photo Credit: Andriy Blokhin / Shutterstock
- Health & hospital spending as a share of total: 12.2%
- Total health & hospital spending per capita: $1,677
- Total health & hospital spending: $66,029,051,000
- Total direct expenditures: $541,102,413,000
Shutterstock
Photo Credit: Andriy Blokhin / Shutterstock
- Health & hospital spending as a share of total: 12.2%
- Total health & hospital spending per capita: $1,677
- Total health & hospital spending: $66,029,051,000
- Total direct expenditures: $541,102,413,000
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US grapples with ‘travesty’ of untreated hepatitis C
Shutterstock
Photo Credit: photo.ua / Shutterstock
- Health & hospital spending as a share of total: 12.8%
- Total health & hospital spending per capita: $1,289
- Total health & hospital spending: $4,190,560,000
- Total direct expenditures: $32,812,538,000
Shutterstock
Photo Credit: photo.ua / Shutterstock
- Health & hospital spending as a share of total: 12.8%
- Total health & hospital spending per capita: $1,289
- Total health & hospital spending: $4,190,560,000
- Total direct expenditures: $32,812,538,000
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US grapples with ‘travesty’ of untreated hepatitis C
Shutterstock
Photo Credit: f11photo / Shutterstock
- Health & hospital spending as a share of total: 14.0%
- Total health & hospital spending per capita: $1,557
- Total health & hospital spending: $4,925,808,000
- Total direct expenditures: $35,283,924,000
Shutterstock
Photo Credit: f11photo / Shutterstock
- Health & hospital spending as a share of total: 14.0%
- Total health & hospital spending per capita: $1,557
- Total health & hospital spending: $4,925,808,000
- Total direct expenditures: $35,283,924,000
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US grapples with ‘travesty’ of untreated hepatitis C
Shutterstock
Photo Credit: mahaloshine / Shutterstock
- Health & hospital spending as a share of total: 14.0%
- Total health & hospital spending per capita: $1,623
- Total health & hospital spending: $12,487,009,000
- Total direct expenditures: $89,455,201,000
Shutterstock
Photo Credit: mahaloshine / Shutterstock
- Health & hospital spending as a share of total: 14.0%
- Total health & hospital spending per capita: $1,623
- Total health & hospital spending: $12,487,009,000
- Total direct expenditures: $89,455,201,000
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US grapples with ‘travesty’ of untreated hepatitis C
Shutterstock
Photo Credit: picsbyst / Shutterstock
- Health & hospital spending as a share of total: 14.2%
- Total health & hospital spending per capita: $1,208
- Total health & hospital spending: $7,431,898,000
- Total direct expenditures: $52,380,770,000
Shutterstock
Photo Credit: picsbyst / Shutterstock
- Health & hospital spending as a share of total: 14.2%
- Total health & hospital spending per capita: $1,208
- Total health & hospital spending: $7,431,898,000
- Total direct expenditures: $52,380,770,000
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US grapples with ‘travesty’ of untreated hepatitis C
Henryk Sadura
Photo Credit: Henryk Sadura / Shutterstock
- Health & hospital spending as a share of total: 15.5%
- Total health & hospital spending per capita: $1,561
- Total health & hospital spending: $4,548,137,000
- Total direct expenditures: $29,333,928,000
Henryk Sadura
Photo Credit: Henryk Sadura / Shutterstock
- Health & hospital spending as a share of total: 15.5%
- Total health & hospital spending per capita: $1,561
- Total health & hospital spending: $4,548,137,000
- Total direct expenditures: $29,333,928,000
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US grapples with ‘travesty’ of untreated hepatitis C
Shutterstock
Photo Credit: Sean Pavone / Shutterstock
- Health & hospital spending as a share of total: 17.1%
- Total health & hospital spending per capita: $1,597
- Total health & hospital spending: $4,736,972,000
- Total direct expenditures: $27,688,049,000
Shutterstock
Photo Credit: Sean Pavone / Shutterstock
- Health & hospital spending as a share of total: 17.1%
- Total health & hospital spending per capita: $1,597
- Total health & hospital spending: $4,736,972,000
- Total direct expenditures: $27,688,049,000
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US grapples with ‘travesty’ of untreated hepatitis C
Shutterstock
Photo Credit: Rob Hainer / Shutterstock
- Health & hospital spending as a share of total: 18.7%
- Total health & hospital spending per capita: $1,687
- Total health & hospital spending: $8,302,347,000
- Total direct expenditures: $44,406,818,000
Shutterstock
Photo Credit: Rob Hainer / Shutterstock
- Health & hospital spending as a share of total: 18.7%
- Total health & hospital spending per capita: $1,687
- Total health & hospital spending: $8,302,347,000
- Total direct expenditures: $44,406,818,000
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US grapples with ‘travesty’ of untreated hepatitis C
Shutterstock
Photo Credit: Jon Bilous / Shutterstock
- Health & hospital spending as a share of total: 18.8%
- Total health & hospital spending per capita: $1,665
- Total health & hospital spending: $17,650,732,000
- Total direct expenditures: $93,667,411,000
Shutterstock
Photo Credit: Jon Bilous / Shutterstock
- Health & hospital spending as a share of total: 18.8%
- Total health & hospital spending per capita: $1,665
- Total health & hospital spending: $17,650,732,000
- Total direct expenditures: $93,667,411,000
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US grapples with ‘travesty’ of untreated hepatitis C
Shutterstock
Photo Credit: Jacob Boomsma / Shutterstock
- Health & hospital spending as a share of total: 18.9%
- Total health & hospital spending per capita: $2,936
- Total health & hospital spending: $1,709,488,000
- Total direct expenditures: $9,029,287,000
Shutterstock
Photo Credit: Jacob Boomsma / Shutterstock
- Health & hospital spending as a share of total: 18.9%
- Total health & hospital spending per capita: $2,936
- Total health & hospital spending: $1,709,488,000
- Total direct expenditures: $9,029,287,000
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US grapples with ‘travesty’ of untreated hepatitis C
Shutterstock
Photo Credit: f11photo / Shutterstock
- Health & hospital spending as a share of total: 19.3%
- Total health & hospital spending per capita: $1,787
- Total health & hospital spending: $9,326,575,000
- Total direct expenditures: $48,273,596,000
Shutterstock
Photo Credit: f11photo / Shutterstock
- Health & hospital spending as a share of total: 19.3%
- Total health & hospital spending per capita: $1,787
- Total health & hospital spending: $9,326,575,000
- Total direct expenditures: $48,273,596,000
