Increase Hepatitis C Virus Screening and Treatment

Transcription

1 18 Increase Hepatitis C Virus Screening and Treatment Situation The number of deaths from liver cancer in Japan has been rising rapidly since 1975, and now stands at more than 30,000 per year. About 80 percent of these cases are due to infection with the hepatitis C virus. 1 The age group with the highest prevalence is those over 40 years old, estimated at 1.9 to 2.3 million carriers. Most infections in this group are due to medical procedures before the 1980s, before disposable medical implements became widespread, and infections from contaminated blood transfusions prior to 1989, when the hepatitis C virus test was introduced to check blood to be transfused. There are few subjective symptoms associated with hepatitis C infection, and the disease can progress from chronic hepatitis to hepatic cirrhosis to liver cancer without the patient being aware of it. 2 However, the hepatitis C virus can be easily detected with a blood test. Therefore, it is important for everyone to be tested once as early as possible in life, and to confirm whether the infection is present. Those who are infected should receive prompt treatment as soon as possible in order to prevent damage to hepatic cells. Hepatitis Viral Test In 2002, the government of Japan offered hepatitis viral testing through the health examinations provided by local governments nationwide as part of the Health and Medical Service Act for the Aged. About 100,000 Hepatitis C carriers were detected out of more than 8.5 million who received the test. 3 Subsequent efforts to increase convenience of testing, by extending free testing to healthcare centers, clinics and hospitals, have been recognized as effective 4 because of steadily increasing numbers of people being tested. The population of viral carriers who were unaware of their infection, estimated at 880,000 in 2000, had declined to an estimated 296,000 by However, people not yet tested cannot be expected to actively seek hepatitis C testing at medical institutions, because of their low awareness to necessity of testing. About 300,000 people are thought to be at risk of developing liver diseases because they lack awareness of their viral status. Therefore, systems should be developed going forward to facilitate passive or incidental hepatitis C testing for this population. One long-cited problem is the low examination rate for employer-based health insurance because the current health checkup program does not provide hepatitis C testing as a mandatory item. In an attitude survey published by the Ministry of Health, Labour and Welfare (MHLW) in 2012, about a half of Japanese citizens responded that they had not received a hepatitis viral test. The top two reasons for this were No opportunity to receive the test, followed by Not included in my regular examination. 5 Only about 50 percent of health insurance unions, in which most employees of large corporations are enrolled, perform hepatitis viral testing as a part of their regular examinations. 6 Hepatitis C Treatment Innovative new drugs have been developed outside Japan where the number of people who are infected with Hepatitis C virus is increasing. Since 2013, in Japan, new classes of drugs have also been developed for clinical uses. Interferon based treatment options combined with an antiviral drug have cured percent of patients infected by the hepatitis C virus, but some patients cannot stay on the therapy because of severe side effects. Patients over age 75 are not eligible for interferon-based treatment options because they are not able to tolerate expected side effects. From 2014, combining oral antiviral drugs without use of interferon can expand the treatment paradigm which could eliminate the hepatitis C virus from more than 90 percent of patients and could prevent progression to hepatic cirrhosis and liver cancer. Caution is required to avoid the induction of drug resistance Lengthening Healthy Lifespans to Boost Economic Growth

2 Aid for Medical Expenses Beginning in 2009, the government of Japan began been disbursing aid for medical expenses associated with treatment of 1 to 2 years of interferon and antiviral drugs for hepatitis. In April 2011, this system was revised so that in principle the out-of-pocket cost to each patient for treatment is only 10,000 yen per month. Subsequently, newly developed antiviral medications have been added to the list of covered treatments under the existing system. New Challenges Although challenges remain in coverage for hepatitis viral testing under employer-based insurance, government hepatitis programs have been successful in increasing the numbers of those receiving virus detection tests. More and more people, however, are not receiving curable treatment options even though they have tested positive, or are not receiving continued medical treatment. The Policy Research Project to Conquer Hepatitis estimates that percent of those infected with the hepatitis C virus are going without receiving treatment, and that the ratio is increasing. A significant challenge going forward is preventing disease progression by enhanced follow-through with patients who test positive for the virus. 8 Therefore, appropriate health policy measures should be applied to those who have been diagnosed as hepatitis C positive, but remained only on traditional treatment by conventional medications, in order to eradicate hepatitis C virus by advanced treatment including use of innovative medicines. Current Policy Establishing Councils in each prefecture and determining strategic plans to fight against hepatitis Establishing a system for more convenient testing Promoting hepatitis viral testing by municipal governments as a health promotion project by individual invitations consultations Promoting invitations to or recommendations of curable treatment options to those who test positive, and get partial reimbursement of testing expenses Medical expense aid system Aggressive education and anti-hepatitis strategies leveraging cooperation with private companies Projects such as the Practical Application Research Project to Conquer Hepatitis, and the Policy Research Project to Conquer Hepatitis Efforts to promote hepatitis viral testing have yielded a certain level of benefits over the long term. Revolutionary new drugs and unceasing efforts by medical professionals have increased cure rates. In addition, expanded aid programs for treatment expenses have enabled virus positive patients fully to access curable treatment options. The efficacy of improved medical technologies and strategies to eliminate liver cancer, however, depends in the end on effectively identifying infected individuals through testing and then having the infected individuals adopt efficient treatment options in order to prevent progression of the disease. A pilot project for follow-up in carriers has been established through both the Project to Prevent Progression and the Policy Research Project to Conquer Hepatitis. If the system from this pilot project can be extended nationwide to provide as many patients as possible with appropriate medical care, it would be a success story that would have a great impact as a best practice in global hepatitis-prevention policy. Recommendations The most effective method would be to revise the National Health Insurance Act to make hepatitis viral testing a mandatory part of specified examinations for those aged 40 or older. At the same time have health insurance unions and municipal governments support hepatitis viral testing as a strongly Lengthening Healthy Lifespans to Boost Economic Growth 89

3 recommended item in their annual health checkup. Further the twin goals of promoting hepatitis viral testing and expanding access to hepatitis curable treatments by establishing a medical system which is promoted collaboratively not only by local governments and hepatic disease center hospitals but also by primary care physicians. Rapidly roll out a system to effectively follow up on those who have been diagnosed as positive. Plan and execute appropriate policy measures through implementing cutting edge treatment options to transform behaviors or cultures both of healthcare professionals and patients in order to completely eradicate hepatitis C virus-related liver diseases. Continue to secure sufficient budgets and to execute eradication initiatives against viral hepatitis, and use the policy of controlling hepatitis as a local role model for preventing or controlling other diseases. References 1. National Cancer Center s Cancer Information Center, Cancer Information Service website: cancer/liver/index.htm 2. Excerpted from materials submitted by committee-member Tanaka, Document 8, MHLW st Council for Anti- 3. Excerpted from materials submitted by committee-member Tanaka, Document 3, MHLW th Council for Anti- 4. Excerpted from materials submitted by committee-member Tanaka, Document 3, MHLW th Council for Anti- 5. MHLW FY2011 Project to Assess Hepatitis Testing Status, Project Report for 12/2011 to 01/2012 Published 08/2012: 6. MHLW FY2011 Project to Assess Hepatitis Testing Status, Project Report for 12/2011 to 01/2012 Published 08/2012: 7. Excerpted from materials submitted by witness Korenaga, Document 4, MHLW th Council for Anti-Hepatitis Strategy 8. Excerpted from materials submitted by committee-member Tanaka, Document 3, MHLW th Council for Anti- 90 Lengthening Healthy Lifespans to Boost Economic Growth

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