Practical Solutions to Reduce Incidence of Liver Cancer. Nancy Steinfurth, Executive Director Liver Health Connection November 2017

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1 Practical Solutions to Reduce Incidence of Liver Cancer Nancy Steinfurth, Executive Director Liver Health Connection November 2017

2 Prevention HBV Vaccinate for hepatitis B Costs between $120 and $370 if paying privately Strongly recommended for high risk populations such as incarcerated, people who inject drugs, men who have sex with men, immigrants from endemic countries, especially Asia

3 Prevention HBV or HCV Screen for the hepatitis B and/or the hepatitis C virus in high risk populations baby boomers, incarcerated, persons who inject, MSM Knowing your status means you can safeguard others, seek treatment, and attain a cure (HCV) or viral suppression (HBV)

4 HCV Testing Law in New York Hepatitis C testing law for baby boomers passed in 2014 Resulted in 51.1% increase in antibody testing Increased linkage to care for newly diagnosed

5 Rates of HCV testing* per 1,000 Medicaid recipients, by age cohort New York,

6 Michigan Medicine Adds HCV prompt University of Michigan added baby boomer prompt to electronic health record in 2016 Increased screening rates from 7.6% to 72% 100% were linked to care, and 67% were prescribed treatment

7 2017 HCV Treatment Access Report Card for all States National Viral Hepatitis Roundtable and Harvard Law School reviewed Medicaid requirements for accessing treatment in all states as of 2017 More than half of the states received a grade D or F because of the significant barriers to access treatment for hepatitis C among Medicaid recipients

8 Tennessee working with FQHCs for HCV testing Recruited 3 Federally Qualified Health Centers More PCP education on HCV Testing and treatment integration Increase testing and linkage to care Total program cost $9,000 (salary support) Carolyn Wester, MD, MPH, with TN Dept. of Health

9 Prevention NASH 40% of cancers are linked to being overweight Approximately 12 million people in the US have NASH, and they are nearly twice as likely as healthy weight people to develop liver cancer Improve diet and increase exercise to prevent fatty liver disease and non alcoholic steatohepatitis (NASH)

10 Patient Perspective on NASH Recent (2017) interviews show Guilt over failure to address diet and lifestyle Fear of disease progression Expect pharma solutions Reluctance to make lifestyle changes Need for earlier diagnosis Need for better understanding of the condition s impact on their life and health

11 Prevention of HBV, HCV, and/or HIV Syringe access programs prevent multiple use of syringes, which reduces public health risk of transmission of HIV, HBV, or HCV Federal funds may be used for syringe access programs, but not the actual syringes

12 Indiana Syringe Exchange 2014 HIV and HCV outbreak in rural Scott county, Indiana led to changing state law to allow creation of syringe exchanges 181 HIV cases, with approx. 92% HCV+ Scott County s program distributed over 97,000 sterile syringes in 2015, harm reduction and substance use services

13 Prevention Each state is required to create a cancer plan add HCV testing of the baby boomer cohort to yours Pass legislation mandating opt out HCV baby boomer testing by PCP or other health professional No fiscal impact because it s covered by the ACA for this age group

14 Prevention Use Medicaid & State Health Department e newsletters to promote vaccination for HBV and testing for HCV Encourage hospitals and the Hospital Association to add electronic medical record prompts for baby boomer HCV testing Mandate HCV testing at intake for methadone clinics, which already perform blood draws

15 Treatment as Prevention HBV treatment reduces viral load and may reduce liver cancer risk HCV patients cured with latest treatments showed a considerably reduced risk of liver cancer Direct Acting Antivirals (DAAs) are cost effective, estimated to cost $10,000 with 99% cure rate