Time bombs in American health care - misdiagnosed diseases

Business & Health, June, 1997 by Ira D. Singer

When diseases make headlines, public awareness can give a boost to prevention and treatment. When major health problems emerge unexpectedly, however, they often take a financial toll on public and private resources in a scramble to manage the mounting numbers of patients and contain spiraling costs.

With so much of U.S. health care and disability coverage paid for by job-based benefits, employers feel the direct impact of those costs. Similarly, they can play a major role in containing costs by remaining aware of developing health problems and, when feasible, instituting programs to educate employees on prevention, detection and treatment and developing farsighted workplace policies.

Amid the ongoing efforts to reform the structure and financing of health care, it can be easy to lose sight of developing problems. Here are four that are currently lurking in the background but could eventually affect millions of people, draining productivity and causing unnecessary deaths.

The third hepatitis

Every day, Denise Carter of Colorado wakes up not knowing which symptom will bother her most. Her body cycles through bouts of intense muscle aches, pounding headaches, depression, flu-like symptoms and "drop-dead fatigue." All of these problems result from hepatitis C and the side effects of therapy. Carter is far from alone in her affliction. Consider the following statistics:

* Close to 4 million Americans are chronically infected with the hepatitis C virus.

* Hepatitis C is four times more prevalent than HIV.

* The disease is the most common cause of chronic liver disease, cirrhosis and liver cancer--and liver transplants--in the Western world.

* Hepatitis C has infected between 35,000 and 150,000 Americans annually over the past decade.

The broad range of that estimate is evidence of the insidious nature of hepatitis C. Upwards of 90 percent of people infected with the virus develop chronic hepatitis, at which point they begin a slow-paced progression, often for decades, without any physical signs of disease. Because most infections remain asymptomatic for so long, only about 30,000 cases are diagnosed each year. A recent Consensus Development Conference at the National Institutes of Health concluded that hepatitis C is responsible for about 8,000 deaths annually, and "without effective intervention that number is postulated to triple in the next l0 to 20 years."

Dr. Miriam Alter, chief epidemiologist of the hepatitis branch at the Centers for Disease Control and Prevention, calculated that in 1992, the economic burden of acute and chronic hepatitis C exceeded $600 million. "Those are conservative numbers," she reminds us, that account for hospitalization and lost work time. "These don't even include the cost of treatment, liver transplants or milder cases of the disease."

Denise Carter, who is affiliated with the Hepatitis C Connection, a patient support group in Colorado, outlines some of the hurdles facing employees. There are the disability benefits. "Most disability criteria revolve around pain and range of motion. They have no idea of how debilitating our fatigue is. Many times you just want to lie down wherever you are and sleep." Then there is social stigma and fear of discrimination. Because 50 percent of hepatitis C in the U.S. is transmitted through intravenous drug use, "many who need help choose not to disclose their diagnosis until it's too late."

Hepatitis C is spread with relative ease through contact with infected blood. Other means of transmission include sexual contact and the sharing of personal items by household members. One group specifically at risk is anyone who had a blood transfusion from around the mid- 1980s to 1991--approximately 3 million a year. A standard blood test will reveal whether further screening for hepatitis C is necessary.

With no vaccine on the immediate horizon, "we are facing an epidemic," says Dr. Don Powell of the University of Texas Medical Branch at Galveston, who headed the NIH conference. "A lot of sick people, many leading very productive lives, will begin to strain our medical and economic resources over the next few decades."

Michael Duffy, a Philadelphia Gas employee, is among those already confronting these realities. Fortunately for Duffy, his Aetna U.S. HealthCare medical plan has paid for the host of diagnostic and confirmatory tests needed to determine proper patient management. His prescription drug plan has picked up the costs of his three weekly injections of alpha-interferon, the only current treatment for hepatitis C. The suggested course of treatment has been six months at a cost of $2,400. But with only a 10 to 20 percent sustained response, the consensus panel recommended 12 months of treatment to increase the likelihood of response. This will push the cost of therapy close to $5,000.

Those who are uninsured or underinsured and unable to pay for treatment can look to such sources as Schering, Plough, manufacturer of the Intron-A brand of alpha-interferon, and its "Commitment to Care" program. It helps patients find reimbursement through state, federal and charitable agencies and sometimes shares or assumes the full cost of therapy once all avenues are exhausted.