Four years ago, the Department of Veterans Affairs launched an ambitious initiative to cure all VA patients with chronic hepatitis C. Today, the department is more than three-quarters of the way, healing nearly 100,000 veterans of the virus, with 26,000 more to go.
Hepatitis C disproportionately affects people born between 1945 and 1965 and is contracted by sharing contaminated needles, getting a tattoo in an unregulated setting, having a blood transfusion before 1992, or having sex with infected partners.
Many of those with hepatitis C at the VA are Vietnam-era veterans who may have contracted it through transfusions, field vaccinations or intravenous drug use. Given that the VA is the largest single hepatitis C care provider in the country, the department set out in 2015 to eradicate the disease within its patient population, reducing their risk for cirrhosis, liver failure, cancer and death.
"We are within striking range of eliminating hepatitis C among veterans under the care of the Veterans Health Administration," VA Secretary Robert Wilkie said in a statement. "Diagnosing, treating and curing hepatitis C virus infection among veterans has been a significant priority for VA."
To date, the VA has spent $814 million on medications to attack the pernicious disease, curing 99,035 veterans, with an additional 16,000 currently undergoing treatment. The department plans to "treat all remaining veterans with HCV who are able and willing to be treated as rapidly as possible," according to VA officials.
"VA continues to enhance prevention efforts and services for those at highest risk of acquiring a new infection or reinfection and veterans with advanced liver disease," a VA spokeswoman told Military.com.
When the hepatitis C drug Sovaldi was introduced to the market in 2014, it was considered a breakthrough that reduced the time to treat patients from one year to 12 weeks. But the drug was expensive, with an estimated cost of nearly $12 billion to treat the VA's hepatitis C patients.
Following congressional hearings and accusations against Gilead Sciences Inc., maker of Sovaldi, of price-gouging, the company and its then-competitor, Janssen Therapeutics, maker of Olysio, negotiated with the VA to decrease the costs.
Today, the main medicines used by the VA to treat hepatitis C include Sovaldi and Mayvret, introduced to the market in 2017, an eight- to 12-week regimen that costs significantly less than other hepatitis C medications. A monthly supply of Mayvret before discounts is roughly $13,800, or $164 a pill.
The VA is so confident in the current available treatments for hepatitis C that it has begun offering patients needing organ transplants the option of receiving one that has tested positive for hepatitis C, followed by treatment for the virus.
The Iowa City VA Health Care System in March successfully transplanted hepatitis C-infected kidneys into four patients, negating their need for dialysis. The innovative strategy, according to Dr. Daniel Katz, the Iowa City transplant surgery director, provides cost-savings while improving veterans' lives.
"The high cost of hep C treatment may hinder rapid adoption of this practice in the private sector, where the transplant center may not be reimbursed for the hep C treatment," Katz said in a news release. "Even with the hep C treatment, though, there will be cost savings over time by removing patients from dialysis."
Across the VA medical system, transplant centers are offering infected organs to VA patients desperate to get off transplant lists. The William S. Middleton Memorial Veterans Hospital in Madison, Wisconsin, and the Tennessee Valley Healthcare System in Nashville offer infected livers and hearts; the Hunter Holmes McGuire VA Medical Center in Richmond, Virginia, will transplant hearts; and the VA Portland Health Care System in Oregon and VA Pittsburgh Healthcare System in Pennsylvania can transplant infected livers.
Navy veteran Jack Jones was treated two years ago for hepatitis C through the VA and recently was offered an infected kidney, which he accepted. After his transplant, he completed a treatment regimen for reinfection and is now back at home in Asheville, North Carolina. He no longer requires dialysis.
"I would recommend this, and the VA, to anyone," Jones said in a news release.
About 2.4 million Americans are infected with hepatitis C, with fewer than half aware that they have the infection, according to the Centers for Disease Control and Prevention.
The CDC recommends that anyone born between 1945 and 1965 be tested for hepatitis C, as well as patients who received clotting factor concentrates before 1987 or a blood transfusion or organ transplant before July 1992.
Health workers involved in needle sticks, injection drug users, those who have gotten a tattoo in a place other than a licensed parlor and dialysis patients also should consider getting tested, according to the CDC.