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 "Going into this, I expected to find it did make sense to wait until
there was a limited amount of liver disease, but what we found to
our surprise is that it makes sense to start treatment at the
earliest change in the liver," said senior author Dr. James Kahn, of
the University of California, San Francisco.
Hepatitis C virus (HCV) is spread by blood. For most people, the
infection becomes chronic, and about 20 percent of HCV infections
result in liver damage, according to the U.S. Department of Veterans
Affairs. Liver damage from HCV can lead to liver cancer or liver
failure severe enough to warrant a liver transplant.
Over 3 million people in the U.S. have chronic hepatitis C, the
researchers write in JAMA Internal Medicine.
Older drugs to fight hepatitis C required almost a year of
treatment, had harsh side effects and didn't always work. A new
class of drugs cuts treatment time to 12 weeks or less and works in
most people with the virus, but cost about $1,000 per day, they add.
While other studies found the new drugs to be cost effective, the
new study looked at whether that's true at each stage of liver
damage. Some insurers won't let patients take the drugs until their
liver disease is advanced.
The researchers created a simulated model to study the
cost-effectiveness of a medicine that contains the drugs sofosbuvir
and ledipasvir and is sold by Gilead as Harvoni.
Other expensive new drugs for HCV include Sovaldi, which costs
$84,000 for a 12-week course of treatment, and Viekira Pak, which
costs about $83,000 for 12 weeks.
The imaginary subjects were 1,000 patients with HCV, of varying ages
and with various stages of liver damage.
The researchers found that using Harvoni to treat people with any
evidence of liver damage from HCV, compared to giving it only to
people with more severe disease, added about one year of healthy
life for less than $50,000, which is considered highly cost
effective.
Results were similar for other new treatments for HCV, the
researchers write.
While treating all stages of liver disease was cost-effective, the
up-front cost is substantial. Treating half of those with hepatitis
C would cost about $53 billion. That cost can be brought down if the
price of the drug also decreases, the researchers write.
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"I think a key policy point here is that cost-effectiveness is
important and this study shows that, but a next and important step
is . . . to address the cost of the drug," said lead author Harinder
Chahal, also of the University of California, San Francisco.
The recent focus on drug prices at the U.S. Department of Health and
Human Services and in Congress is positive, he said.
Aside from price, there are other challenges to delivering treatment
to all those infected with hepatitis C, wrote Dr. Hal Yee Jr. in an
editorial.
"The paper is nice, because it provides us with evidence that it’s
cost effective to treat people early, but it’s not efficient if you
don’t have the resources to treat people early," said Yee, who is
affiliated with the Los Angeles County Department of Health Services
in California.
For example, he writes in his editorial, people may have trouble
finding doctors who can manage their HCV treatment.
"I think we need to think rationally about how to provide the care
and reduce disparities of care," he told Reuters Health.
SOURCE: http://bit.ly/1SfN5Ui and http://bit.ly/1SfNbev JAMA
Internal Medicine, online November 23, 2015.
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