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KERRY & HONDA: Disrupting a deadly disease

Hepatitis defense can save thousands of lives a year

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A silent killer is loose in America. It contributes to the death of 15,000 Americans a year and threatens the health of 5.3 million more. It is more common than HIV/AIDS. It is the leading cause of liver cancer - a cancer that is on the rise and continues to be a fatal and costly disease. Yet it remains unrecognized as a serious threat to public health.

This silent killer is viral hepatitis. Most people don't even know they have it until years later, when it causes cancer or liver disease. But we can help avoid such needless tragedies with prevention and surveillance programs and by educating Americans on the pervasive nature of hepatitis B and hepatitis C.

A first step is to change the way viral hepatitis is diagnosed and treated, and that is why we have introduced legislation in the Senate and the House to provide almost $600 million over the next few years to treat this deadly epidemic. Our legislation will make our health care system more efficient. More important, it will save lives.

The bills we have introduced closely mirror the recommendations in a recent report from the Institute of Medicine (IOM), "Hepatitis and Liver Cancer," which calls for a national strategy to prevent and control hepatitis B and C.

The report concludes that the current approach is not working: Americans at risk for hepatitis or living with it do not know it, and health providers are not screening for it. That should come as no surprise because there is no federal funding of core public health services for viral hepatitis. Nor is there any federally funded chronic hepatitis B and C surveillance system.

Not surprisingly, the IOM report recommends increased information and awareness about chronic viral hepatitis among health care providers, social service providers and the public; improved surveillance for hepatitis B and hepatitis C; and better integration of viral hepatitis services.

Our call for a national strategy is not unlike IOM's. Specifically, our bills increase interagency coordination between the Centers for Disease Control and Prevention (CDC), the National Institutes of Health (NIH), the National Cancer Institute (NCI), the Health Resources and Services Administration (HRSA), the Substance Abuse and Mental Health Services Administration (SAMHSA), the Agency for Healthcare Research and Quality (AHRQ) and the Department of Veterans Affairs (VA).

It sets up programs to improve understanding of hepatitis B and C and requires the CDC to integrate them into existing immunization, prevention and control programs and support counseling. It also expands current vaccination programs and establishes a national chronic and acute hepatitis B and C surveillance program to identify incidence and prevalence in viral hepatitis and liver cancer.

Hepatitis B is 100 times more infectious than HIV and, left untreated, can cause liver disease, liver cancer and premature death decades after infection. About 2 billion people worldwide have been infected with hepatitis B, and about 170 million people are chronically infected with hepatitis C. Tragically, two-thirds of those infected, on average, are unaware of their status, which increases the chance of spreading the disease.

We cannot afford to be silent anymore. Our fellow citizens are dying daily because our nation lacks a comprehensive prevention, education and medical management program. Each year, about 15,000 people die from liver cancer or liver diseases related to hepatitis B and hepatitis C. That's more than 40 deaths every day.

Beyond the tragic and preventable loss of human life, there is the economic cost. Although the costs of education, research and treatment are not trivial, they are substantially less than the annual health care cost attributable to viral hepatitis in the United States.

Without effective prevention and vaccination methods, chronic hepatitis B and C are expected to cost our country billions of dollars in the coming years. The baby-boomer population is estimated to account for two out of every three cases of chronic hepatitis C. As these Americans age and enter into Medicare, they are likely to develop complications and require expensive medical interventions. In the next decade, the costs of hepatitis C to commercial insurance and Medicare will more than double, and within 20 years, Medicare costs will increase fivefold. Projecting further out, over the next 20 years, total medical costs for patients with hepatitis C infection could increase more than 2.5 times - from $30 billion to more than $85 billion.

Contrast the costs for early detection and intervention with the costs for treatment post-infection. The costs for hepatitis B vaccinations vary but range from $75 to $165, whereas treatment can cost up to $16,000 per year. Screening for hepatitis C is also relatively inexpensive compared to treatment, which can cost up to $25,000 per year. Untreated, these infections will develop into liver disease that can cost up to $110,000 per hospital admission.

Moreover, the United States is entering an era of effective therapy for chronic viral hepatitis. Improvements in current treatment and therapies are likely to be approved in the next several years that can double cure rates and cut the length of treatment in half and could confer increasingly greater benefits.

Until then, though, we have no time to waste. Our legislation, along with strategic investments in public health and prevention programs, will save billions of dollars and the lives of tens of thousands of people all over America. We urge our colleagues to support activities that promote early detection and education. Our legislation will sound the alarm on this silent killer.

Sen. John Kerry is a Massachusetts Democrat, and Rep. Michael M. Honda is a California Democrat.

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