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Wednesday, January 27, 1999 Bill McAllister

VA to Offer New Hepatitis C Drugs, Costly Treatment Program Targets a Disease Far More Common in Veterans

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.

© Copyright 1999 The Washington Post Company

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