Proposed Legislation Would Require Baby Boomers to Be Offered Tests for Hepatitis C

Andrew Kitchenman | January 29, 2015 | Health Care
Doctors and hospitals protest that mandated screening would be expensive and time-consuming

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In response to the CDC recommendations that all baby boomers be offered tests for hepatitis C, a bill that would mandate this screening has been introduced in the Legislature. But doctors and hospitals contend that the same results could be obtained by relying on physicians’ knowledge of their patients, and would save time and money.

Hepatitis C led to 16,627 deaths nationally in 2010 and has surpassed HIV/AIDS as a cause of death. Three-quarters of 2.7 million to 3.9 million people with the disease are baby boomers. In most cases, the blood-borne infection was contracted through needle sharing or from blood transfusions or organ donation before screening began after hepatitis C was identified in the late 1980s.

The bill sponsored by Sen. Joseph F. Vitale (D-Middlesex) is based on a recommendation by the U.S. Centers for Disease Control and Prevention that everyone born between 1945 and 1965 should be screened for the virus, which is a leading risk factor associated with liver cancer. It would require every hospital and healthcare provider to offer the test to people born in that time period, unless they’re being treated for a life-threatening condition or have previously been offered the test.

The bill was endorsed last winter by the New Jersey State Board of Medical Examiners, which oversees doctors’ licenses. The Senate Health, Human Services and Senior Citizens Committee voted to release the bill on Monday.

Dr. Andrew de la Torre, a Clifton liver specialist and surgeon, said that as treatment for the disease has become more effective, it’s essential that cases be caught early, before damage to the liver has been done.

“As a liver transplant surgeon for well over a dozen years, you get tired of watching people needlessly die who could have been caught earlier and treated,” he said.

The condition is treated with medication. The drugs Sovaldi and Viekira Pak have gained attention for their high prices – roughly $84,000. But that cost can be less expensive than the repeated hospitalizations that resulted from earlier treatments, de la Torre noted.

The Medical Society of New Jersey, the state’s largest doctors’ group, said that offering any service at every encounter with a patient is never the best practice or best use of the patient’s time. It also said that the bill would lead to overlapping responsibilities, since emergency-room doctors wouldn’t necessarily have access to a patient’s primary-care records to know whether he or she had previously been offered the test. (The healthcare system is moving toward providing better access to electronic health records.)

The society also argues that specialists like doctors treating patients for cancer would know whether offering the test is a good use of time. Further, it asserts that it’s wrong to mandate specific tests for all patients, since each patient is unique.

The New Jersey Hospital Association has also come out against the bill. Association Vice President Neil Eicher said his group would support the measure if it removed the mandate on hospitals, adding that hospitals are the most expensive setting for healthcare and that primary-care providers are better positioned to treat the virus.

De la Torre rejected the argument over cost, saying that the test costs anywhere from $9 to $15. He added that most people who are referred to a primary-care office for a test don’t follow up, so it’s better to do the test immediately at the hospital.

He also opposed the society’s position.

“Nobody likes to be told what to do, but sometimes you have to step back and say, ‘Look, there’s far more to be gained by doing this,’ ” de la Torre said, noting that liver cancer has been one of the fastest-growing forms of cancer.

Vitale said to Eicher that hospitals exist to provide services like testing for hepatitis C.

“If we left out hospitals — if we only just made it primary care — we’d be passing up the opportunity to potentially test and treat thousands of men and women in this state who are otherwise asymptomatic and may not realize that they have hepatitis C until it’s too late,” he said. “I’ve seen people realize it too late and I think we have an obligation we prevent from happening.”

Vitale added that he doesn’t “get the opposition.”

“It seems that the arguments are more a matter of inconvenience and principal rather than how it is we can save someone’s life,” Vitale said.

The bill received support from Viekira Pak maker AbbVie, as well as the American Liver Foundation, the American Legion, the New Jersey Fire Chiefs Association, and the Drug Policy Alliance, among others.