DDW Daily News - Pricing remains main barrier to HCV eradication

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Pricing remains main barrier to HCV eradication

Posted By: DDW Daily News on: May 19, 2015

In: AASLD, By Society, DDW Daily News

Hepatitis C (HCV) can be eradicated, but the question is whether the global community, or even a single nation, has the financial and political will to do it.

Brian Edlin, MD

“This is a very exciting time in hepatitis C,” said Brian Edlin, MD, associate professor of medicine at Weill Cornell Medical College. “We now have safe, easy treatments that are quite effective. These potent tools can be used to cure disease and interrupt transmission. We are in a position to talk about eradication of hepatitis C; price is the major barrier.”

Eradication is technically feasible, Dr. Edlin said during a Monday morning AASLD Clinical Symposium, but not likely until current pricing policies change.

The latest generation of HCV treatments effectively cure the disease in 90 to 95 percent of patients, said Nancy Reau, MD, FAASLD, associate professor of medicine, University of Chicago, IL. The utilization of liver transplantation for HCV-related disease is projected to fall dramatically during the next decade. The greater the proportion of HCV patients treated, the smaller the need for liver transplantation.

“It will take five to ten years to see the full impact of highly effective HCV treatment, but the benefits are enormous,” she said. “Effective treatments will improve neurocognitive function, lower rates of glycemic resistance and diabetes, reduce associated cardiovascular disease, improve the quality of life, reduce transmission, lower rates of work absence and reduce rates of health-care utilization.”

The new generation of HCV drugs, sofosbuvir, ledipasvir, paritaprevir/r, ombitasvir, dasabuvir and combination regimens, cost between $85,000 and $200,000, depending on the regimen and duration of treatment. Repeated studies have shown that all of these regimens are cost-effective, Dr. Reau said, ranging from less than $20,000 per quality adjusted life year (QALY) gained to just over $55,000 per QALY gained.

The problem is financial. At current prices, HCV treatment is expected to cost $136 billion over the next five years in the U.S. alone.

“HCV treatment is cost-effective, but the costs are not sustainable,” she said. “We are seeing that being cost-effective does not mean affordable or accessible.”

The high price of HCV treatment sows confusion and doubt, Dr. Edlin said. Payors ration access to limit their costs, sparking conflict between providers, patients and payors. Access is not being determined by medical necessity but by factors such as advanced disease, lack of substance abuse, lack of malignancy, provider experience and onerous prior authorization procedures.

Cost is not the issue, he said. Sofosbuvir costs about $1 per tablet to manufacture. That same tablet is priced about $1,000.

“Pricing decisions are not in the best interests of patients or providers,” Dr. Edlin said. “Pricing decisions are in the best interests of pharmaceutical manufacturers. We physicians are almost the sole voice for our patients’ interests. If we allow pricing policies to be set based on manufacturers financial goals, many patients with hepatitis C will progress and die, transmission will continue and any hope of eradication is lost. These new regimens offer the possibility of eradicating hepatitis C, but we need a public consensus to make it happen. All people with hepatitis C deserve treatment.”

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Source
http://ddwblog.org/2015/05/aasld-live-1/