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HCV Treatment Cost-Effective Unitedhealthcare's OPTUMRx PBM says
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Report on new HCV drugs from Optum, a consulting subsidiary of United Healthcare - (05/29/14) ......"Can drugs as expensive as these really be cost-effective? The answer is yes
"Hepatitis C-infected patients incur higher health care costs compared with a non-infected population matched by sex, age, and healthcare enrollment.1 Because costs are driven largely by end-stage liver disease, liver transplants and cancer, total hepatitis C- related health care expenses can be expected to decrease over time as successfully treated patients avoid progressing to more severe forms of the disease.14
Based on this experience, it is certainly possible that the combination of higher cure rates and reduced side effects, combined with reduced treatment times may mean even greater cost-effectiveness in the future."
Additional highlights from the Optum article, Hepatitis C: Big changes coming soon:
· "Until relatively recently, hepatitis C had been difficult to treat and nearly impossible to cure with existing therapies. Without the new and pending wave of highly effective treatments, is was estimated that the cost to treat the currently infected group of Americans over their estimated survival span could reach $360 billion in today's dollars. That translates into an annual health care cost as high as $9 billion for the affected U.S. population."
· "It is useful to briefly review the major advances in clinical efficacy for hepatitis C medications over just a few years. Traditional therapies (prior to 2011) commonly reported cure rates in the range below approximately 50 percent. The current state-of-the-art therapies, Incivek and Victrelis, (in combination with injected interferon and ribavirin pills) produce cure rates as high as 63%- 79% in first-time treatment patients. The experimental new drugs and combinations of drugs being tested now are reporting much higher cure rates. At least one has reported cure rates up to 100 percent in trials and several other combinations are reporting cure rates above 80 and 90 percent, albeit still in small studies."
· "At this time we simply do not know what prices will be for the new drugs, since none of the manufacturers has committed to a number. This hasn't prevented great speculation, including predictions that the new Gilead drug (sofosbuvir) may cost up to $100,000 per patient for a course of treatment."
· "In addition to their improved clinical effectiveness, Victrelis and Incivek are also very expensive. Recall that they must be used in combination with the previously existing therapy (injected interferon and ribavirin pills) which costs approximately $15,000 to $20,000 for 48 weeks of therapy. Adding Victrelis and Incivek means an additional cost of nearly $50,000 per course of treatment."
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hepatitis C drugs can eliminate the virus completely - once it's gone, people are cured. Drugs against HIV just suppress the virus, so must be taken for a lifetime......."Maybe we decide that $100,000 is a worthwhile investment to cure someone of an otherwise devastating chronic infection," Graham says. After all, it can now cost up to $300,000 to treat patients with advanced hepatitis C, using less effective and more harrowing regimens.....clock is ticking for people infected with hepatitis C, most of whom don't know it......"We have a very narrow window of time to find as many people as possible and to cure them as quickly as possible, if we want to make a substantial impact on their disease progression, as well as on those very expensive complications in the future," Graham says. "You have to treat them now."
http://www.npr.org/blogs/health/2013/12/30/256885858/-1-000-pill-for-hepatitis-c-spurs-debate-over-drug-prices
Hepatitis C Vs. HIV
There are some interesting parallels between the new hepatitis C drugs (Sovaldi and others in the pipeline) and the antiviral drugs that came out 20 years ago to treat HIV. Both classes of drugs were initially very pricey. Both revolutionized the treatment of chronic, lethal infections that are major global health problems.
But there are big differences. First, hepatitis C is actually a much bigger public health threat than HIV - a fact that has received little attention. Secondly, the new hepatitis C drugs can eliminate the virus completely - once it's gone, people are cured. Drugs against HIV just suppress the virus, so must be taken for a lifetime.
Given that latter point, of Beth Israel Deaconess Medical Center in Boston thinks that the high cost of the new hepatitis C treatments might be justified.
"Maybe we decide that $100,000 is a worthwhile investment to cure someone of an otherwise devastating chronic infection," Graham says. After all, it can now cost up to $300,000 to treat patients with advanced hepatitis C, using less effective and more harrowing regimens.
Graham is a hep-C specialist. So she knows firsthand how the slow-moving virus kills patients by destroying their livers and causing liver cancer. The virus is the main reason that nearly 17,000 Americans are waiting for a liver transplant.
Getting Care Early
Another factor to consider, Graham says, is that the clock is ticking for people infected with hepatitis C, most of whom don't know it
"We have a very narrow window of time to find as many people as possible and to cure them as quickly as possible, if we want to make a substantial impact on their disease progression, as well as on those very expensive complications in the future," Graham says. "You have to treat them now."
The urgency is greater for people who are infected with both HIV and hepatitis C because having both diseases accelerates the liver damage from hepatitis.
Older hepatitis C regimens carry many , such as fatigue, muscle aches, fever, skin rashes, anemia, depression, nausea and loss of appetite. These side effects have been deterrents to treating people before they developed clear signs of liver damage.
But the availability of gentler therapies is an incentive to beginning treatment earlier, before people develop signs and symptoms of liver scarring. That approach greatly expands the number of people eligible for treatment - and the potential market for Sovaldi and upcoming drugs.
Graham thinks Gilead should factor the larger market size into the drugs' price.
She notes that Gilead more than $11 billion to acquire a smaller company that developed Sovaldi. She acknowledges that Gilead should be allowed to recoup that investment.
On the other hand, "you only need about 150,000 people to recover that cost," Graham says. "And so, if you're treating 2 million people, once you have recovered your cost, then I think it's ... I don't want to say it's unfair, but it does start feeling more exploitative."
'An Affordable Range'
Graham says she thinks once Gilead has recovered its investment cost, it ought to cut the price of Sovaldi.
"That's very unlikely that we would do that," responds Alton, Gilead vice president. "I appreciate the thought."
Alton says critics should "look at the big picture."
"Those who are bold and go out and innovate like this and take the risk - there needs to be more of a reward on that," he says. "Otherwise, it would be very difficult for people to make that investment."
Gilead will help U.S. patients pay for Sovaldi if they can't afford it, Alton says, or the company will help them look for drug coverage. And Gilead will charge far less for a course of the drug in places such as India, Pakistan, Egypt and China, where most people with hepatitis C live.
Pressed on how low the price of a cure will go, Alton says: "I don't think we'll be able to get it into the low hundreds. But I think we can get it into an affordable range for them. It'll be from the high hundreds to low thousands for these types of markets."
It took more than 10 years for many people in developing countries to get access to life-saving HIV drugs. Advocates hope it won't take anywhere near that long to start curing hepatitis C.
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