While a new generation of safer, more effective oral medications to treat hepatitis C patients may cost tens of thousands of dollars for a 12-week regiment, investing in these new therapies could generate savings estimated at more than $3.2 billion annually in the U.S. and five European countries, according to a new study (abstract 228) released today at Digestive Disease Week® (DDW) 2015. These savings would have a significant economic impact on society.
Despite advances, issues remain in fight to eradicate hepatitis C
Posted By: DDW Daily News on: May 17, 2015
Nancy S. Reau, MD, FAASLD, associate professor of medicine in the department of hepatology at the University of Chicago Medical Center, will discuss some of these issues on Monday during the AASLD State-of-the-Art Lecture Issues in Hepatitis C: Identification, Access to Care and Cost.
As noted in a 2014 journal article that Dr. Reau co-authored, a 12-week course of therapy with one of the new antiviral drugs can be in excess of $84,000. Compared to the cost of a liver transplant, which is estimated at $600,000 on average on the United Network for Organ Sharing’s (UNOS) Transplant Living website, that might seem like a bargain. But, despite increasing competition among pharmaceutical companies, cost is still an obstacle, Dr. Reau said.
The cost issue is further complicated by the fact that many HCV patients come from socio-economic groups where many still lack insurance and substance abuse is prevalent, Dr. Reau said. Access to care is also an issue.
“The medicine could be dirt cheap, but if you don’t have enough people to actually give care then you are still going to have access issues,” Dr. Reau said.
The current dearth of providers presents challenges not only for immediate treatment, but also for follow-up to ensure patients are cured, don’t get re-infected, and for people with advanced disease, that they don’t have long-term consequences as opposed to going on to live normal lives.
Yet some observers are concerned about expanding the provider pool now that HCV is considered a curable disease. Dr. Reau said she’s in the camp that argues more specialists are needed because of the increasing prevalence of other liver diseases.
Screening is another challenging topic. While most hepatologists don’t consider screening to be controversial, Dr. Reau said “we still have people who believe that expanding screening for HCV is potentially harmful and not cost effective.”
Risk-based screening is universally endorsed, but the consensus ends there.
In 2012, the Centers for Disease Control and Prevention recommended one-time screening of all adults born between 1945 and 1965, as this group has the highest concentration of HCV infection in the U.S. Dr. Reau said traditional risk factors such as IV drug use and blood transfusions prior to 1991 contribute to a higher prevalence among baby boomers, but it’s mainly due to iatrogenic transmission through activities causing surreptitious blood exposure. This could be mundane things like getting a haircut or going to the dentist, as baby boomers were born before universal precautions for HCV were implemented.
Another school of thought is to screen other at-risk groups, such as people who emigrate from high-prevalence countries or the pregnant population. But the larger the net, the more controversial the practice becomes and the higher the risk of overscreening, Dr. Reau said.
Please refer to the schedule-at-a-glance in Monday’s issue for the time and location of this and other DDW® events.
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Posted By: DDW Daily News on: May 17, 2015
With headlines proclaiming that new antiviral drugs have forever changed the game for patients infected with hepatitis C (HCV), it’s easy to forget that issues still remain in identifying and treating the disease.
Nancy S. Reau, MD, FAASLD, associate professor of medicine in the department of hepatology at the University of Chicago Medical Center, will discuss some of these issues on Monday during the AASLD State-of-the-Art Lecture Issues in Hepatitis C: Identification, Access to Care and Cost.
As noted in a 2014 journal article that Dr. Reau co-authored, a 12-week course of therapy with one of the new antiviral drugs can be in excess of $84,000. Compared to the cost of a liver transplant, which is estimated at $600,000 on average on the United Network for Organ Sharing’s (UNOS) Transplant Living website, that might seem like a bargain. But, despite increasing competition among pharmaceutical companies, cost is still an obstacle, Dr. Reau said.
The cost issue is further complicated by the fact that many HCV patients come from socio-economic groups where many still lack insurance and substance abuse is prevalent, Dr. Reau said. Access to care is also an issue.
“The medicine could be dirt cheap, but if you don’t have enough people to actually give care then you are still going to have access issues,” Dr. Reau said.
The current dearth of providers presents challenges not only for immediate treatment, but also for follow-up to ensure patients are cured, don’t get re-infected, and for people with advanced disease, that they don’t have long-term consequences as opposed to going on to live normal lives.
Yet some observers are concerned about expanding the provider pool now that HCV is considered a curable disease. Dr. Reau said she’s in the camp that argues more specialists are needed because of the increasing prevalence of other liver diseases.
Screening is another challenging topic. While most hepatologists don’t consider screening to be controversial, Dr. Reau said “we still have people who believe that expanding screening for HCV is potentially harmful and not cost effective.”
Risk-based screening is universally endorsed, but the consensus ends there.
In 2012, the Centers for Disease Control and Prevention recommended one-time screening of all adults born between 1945 and 1965, as this group has the highest concentration of HCV infection in the U.S. Dr. Reau said traditional risk factors such as IV drug use and blood transfusions prior to 1991 contribute to a higher prevalence among baby boomers, but it’s mainly due to iatrogenic transmission through activities causing surreptitious blood exposure. This could be mundane things like getting a haircut or going to the dentist, as baby boomers were born before universal precautions for HCV were implemented.
Another school of thought is to screen other at-risk groups, such as people who emigrate from high-prevalence countries or the pregnant population. But the larger the net, the more controversial the practice becomes and the higher the risk of overscreening, Dr. Reau said.
Please refer to the schedule-at-a-glance in Monday’s issue for the time and location of this and other DDW® events.
Another real and serious problem is going to be the approx. 5% of patients who will fail these new thrapies and be left with resistant mutations that can last for years,if not forever.
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