Focusing on hepatitis C in the local Baby Boomer population
Hepatitis C is a leading cause of liver cancer and the leading cause of liver transplants; people born during 1945-1965 account for 73% of all hepatitis C- associated mortality. –Centers for Disease Control and Prevention
Nine U.S. states represent more than half (52%) of all people living with Hepatitis C nationwide.* One of those is Pennsylvania. Estimates in 2019 put the number in our state at 59,001 and up. After screenings for hepatitis C were recommended for people now ages 54-74, John Nuschke Jr., MD, a family medicine physician practicing in Allentown, decided to help fellow physicians with that requirement.
“The legislation, while certainly valuable, meant doctors had to add one more extra thing to their long list of to-dos, so it was met with some frustration,” says Dr. Nuschke. “I decided I wanted to help out and applied for a grant for funding from Valley Preferred.”
Fifty primary care physicians in the same practice group gave their permission to send about 16,000 letters to their patients who met the criteria for hepatitis C. The data was gathered from Lehigh Valley Health Network’s EMR by the practice staff, who are fully HIPAA-compliant. The letter urged patients to see their doctor for a hepatitis C screening. Dr. Nuschke lined up physicians willing to talk to the patients, counsel them, look at their lab results, and follow up.
About 22 percent of patients who received the letters complied and obtained screenings with their doctor. Of those 3,500 patients, 45 tested positive for hepatitis C; however, they were not all at risk. In the end, 10 people were identified as having the disease, allowing LVHN physicians the opportunity to treat them and save them the serious consequences of hepatitis C when undiagnosed.
In terms of savings, this nine-month-long effort was “a home run,” according to Dr. Nuschke. The cost of medication for treating the disease, which is 98 percent effective, is $100,000. The cost of a liver transplant, which can be the consequence of hepatitis C, can be as high as $900,000, including a long-term stay in a hospital’s transplant unit. Considering 10 patients were affected, the savings soar to the $8 million range.
“The savings are one thing, but the impact on the patients is huge. These patients reduced the risk for cancer, the consequences of long-term liver disease, or waiting for a transplant and considerable loss in quality of life,” says Dr. Nuschke. “This was an incredibly important project for me. The best outcome was doing something good, and truly helping people I didn’t even know.”