Q&A: How much would Hepatitis C cure cost?

Q&A: How much would Hepatitis C cure cost?
By Wire Report , Herald-Tribune
Tuesday, May 20, 2014

Q: Who should receive those expensive new drugs that can cure hepatitis C?

A: If all 3 million people estimated to be infected with the virus in the United States were treated with the drugs, at an average cost of $100,000 per person, the amount spent for prescription drugs in the country would double, from about $300 billion a year to more than $600 billion.

That prospect has inspired an unusually blunt public debate: Should such treatments -- one drug costs $1,000 a pill -- be limited to the sickest patients, or should the drugs be immediately available to everyone? And should those in taxpayer-funded programs have the same access?

The issues are especially contentious because the drugs, Sovaldi by Gilead Sciences and Olysio by Janssen Therapeutics, are an advance in treatment and offer a cure for many people; they are not just medicines that ease symptoms or extend life.

This is not an isolated predicament. Specialty drugs account for less than 1 percent of all prescriptions but more than a quarter of spending. Other high-cost specialty medicines in the pipeline include treatments for high cholesterol and diabetes.

"This is the tip of the iceberg," said Steven Pearson, president of the nonprofit Institute for Clinical and Economic Review. "We have about a year or two as a country to sort this out" before more specialty drugs hit the market.

A panel from the American Association for the Study of Liver Diseases and the Infectious Diseases Society of America said the new hepatitis drugs should be preferred treatments for most of those infected.

"We just put down the best regimen for the individual," said Gary Davis, a hepatitis expert and panel co-chairman. "We recognize cost issues are really important, but we are clinicians, not the people who should be addressing that."

But in April, a panel for the Department of Veterans Affairs suggested that doctors should use the drugs mostly for patients with advanced liver disease, including those awaiting transplants. The VA panel said most patients at early stages of the disease should consider waiting for drugs that may prove superior. Analysts expect those drugs to be available within a year or two.

Prioritizing treatment for those with advanced liver disease was also suggested by the California Technology Assessment Forum, a panel sponsored by the Blue Shield of California Foundation.

Ryan Clary, executive director of the National Viral Hepatitis Roundtable, a patient group, calls such limits "absolutely, rationing." His group, which receives drug industry funding, wants the drugs to be broadly available.

"There are plenty of reasons a person with hepatitis C would like to have the virus out of their body," he said. "To say, 'We want you to hold off until you start to get sick,' is really problematic."

The hepatitis drugs are not the most expensive drugs on the market, but their cost is of concern because of the large number of people infected.

In the United States, drugmakers set prices based on development costs, as well as on what the market will bear, with companies demanding higher returns for products that have little or no competition. Until they lose patent protection, brand-name drugs in the United States often are able to garner the highest prices in the world.

Prices generally fall sharply once generic rivals hit the market.

–Julie Appleby, Kaiser Health News