Washington Post
Wednesday, January
27, 1999 Bill McAllister
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By Bill McAllister
Washington Post
Staff Writer
Wednesday, January
27, 1999; Page A19
The Department of Veterans Affairs today will announce plans
to offer a costly new drug treatment to former military personnel suffering
from hepatitis C, a blood-borne virus that can cause serious liver damage
and is far more common than the AIDS virus.
The decision to offer the expensive, year-long drug treatment is expected
to be controversial, but the VA's top doctor defends the decision as "an
aggressive public health approach" to a potentially deadly disease that
is much more common among veterans than the general population.
No other federal agency has announced such an ambitious attack on the disease
since the Food and Drug Administration last summer approved a combination
drug therapy to treat hepatitis C, a liver ailment known as HCV. Once known
as "non-A, non-B hepatitis" after better-known strains of the liver ailment,
it is believed to affect nearly 3.9 million Americans and kill 8,000 to
10,000 people a year.
Labeled "a silent epidemic," HCV is believed to have been spread by intravenous
drug use and blood transfusions before 1992, when all blood donations began
to be screened for the virus. Public health officials have described HCV
as the most common chronic blood-borne infection in the United States;
it may account for 40 percent of all liver disease.
Kenneth W. Kizer, the VA's undersecretary for health, says the department's
package, costing $12,000 to $15,000 a year per patient, is a harbinger
of costly medical treatments to come as new drugs become available to treat
chronic ailments in the nation's 26 million veterans.
"It's a big-ticket item," he said in an interview. "There is a huge cost
that is involved. We acknowledge it, but I don't know what choice we have."
Kizer said the costs of the HCV initiative--$250 million to $300 million
this year alone--have provoked questions outside the VA about the necessity
of the effort. He declined to identify his critics, but said the costs
likely will rise sharply as more veterans are tested. Those veterans who
test positive will have the option of taking the new drug treatment.
While the VA has enough funds in its current budget for the first year
of the initiative, Kizer said: "I have grave doubts about [funding for]
2000." He said the costs should rise next fiscal year to $400 million to
$500 million.
Even "at government prices," Kizer maintained that the HCV initiative is
a cost-effective way to fight a disease that VA surveys have found is widespread
among veterans. HCV can lead to other costly medical treatments, including
liver transplants.
VA officials say that a six-week study at the veterans hospital in Northwest
Washington found 20 percent of the patients tested positive for HCV. A
study at the San Francisco VA hospital found 18.9 percent of the patients
undergoing routine blood work tested positive and the department said more
than half of all its liver transplant patients have HCV.
Those findings alarmed VA officials because they are far higher than the
1.8 percent of the general population that is believed to be affected by
the disease. To treat the veterans, many of whom are unaware they are carrying
the virus, the VA established two research facilities, in Miami and San
Francisco. Since then the Food and Drug Administration and the Centers
for Disease Control have issued treatment protocols for HCV, steps that
Kizer said influenced the VA's action.
A former California state health commissioner, Kizer has developed a reputation
as a forceful leader of the VA's system of 171 hospitals, closing some
facilities and redirecting the agency toward outpatient care for more veterans.
With this HCV initiative, he is pushing the department to take the lead
in addressing what former surgeon general C. Everett Koop has called "one
of the most serious public health crises faced in this century."
In October, the House Committee on Government Reform and Oversight endorsed
a report that was highly critical of the Department of Health and Human
Services' "lackluster response to the public health threat posed by widespread
hepatitis C infection."
Yesterday, Rep. Christopher Shays (R-Conn.), chairman of the subcommittee
that prepared the critical report, welcomed the VA effort.
"It is a belated, but urgently needed, VA program," he said through a spokesman.
"We welcome the move to help Vietnam veterans, some of whom may have been
infected with hepatitis C through contaminated blood. . . ."
Those veterans who choose the new treatment for hepatitis C face a difficult
program. Side effects of the drugs involved--interferons and ribavirin--are
said to be serious, and include depression, anemia and flu-like symptoms.
Only half who take the treatments improve, and those who do are not said
to have been cured, but only to have eliminated signs of active liver disease.
SOURCE:
THE WASHINGTON POST