December 16, 2015
The cost of DAAs for HCV is generally expensive, so teams of researchers are beginning to assess the impact of drug prices on budgets of health systems. (Costs and prices listed below are in $US.)
"The retail costs of the antivirals for a single course of the most common HCV treatment regimen approaches $100,000," said Hal Yee, MD, PhD, from the Los Angeles County Department of Health Services. Furthermore, he notes that in 2014 total spending on medications for the treatment of HCV exceeded $12 billion. He said that this amount "represented more than 3% of the nation's total prescription drug [spending]." Dr. Yee added that much of the increase in spending on new drugs occurred because of the costs of HCV therapy. Therefore, he concluded that "... funding to treat every [HCV] infected person immediately appears problematic."
A team of researchers at the University of California at San Francisco (UCSF) has been investigating the cost-effectiveness of HCV treatment for all patients in the U.S. The team focused on the strain of HCV most common in the U.S. -- genotype 1. The researchers found that providing treatment to patients when there was a relatively small degree of liver injury was cost effective. However, they also said that "if only 50% of eligible patients with HCV genotype 1 were to be treated with the combination of sofosbuvir + ledipasvir [sold as Harvoni] during the next five years, the cost of [this treatment] in the U.S. would be $53 billion."
Furthermore, the UCSF researchers acknowledged that some health plans and government agencies are able to negotiate a reduction in the cost of medicines with pharmaceutical companies, though the scope of discounts is not usually made public. The researchers added that if payers were able to negotiate a "46% reduction in the [average price of drugs], the cost of treating 50% of patients with HCV genotype 1 during the next five years could be as high as $29 billion." According to the researchers, this cost could be offset by a projected "$3 billion in savings in the management of chronic HCV and advanced liver disease," presumably because so many people would have received treatment and would be cured and not require hospitalization.
The UCSF team also made the following statement:
"Market or political forces may result in significantly decreased drug costs in the next several years, and a subset of patients, given the slow progression of HCV, may be treated at a lower cost without a risk for serious clinical progression."
The work of the different research teams involved in trying to envision and calculate the scale and cost of interventions needed to effect massive change on the HCV epidemic is important. Other researchers need to confirm the robustness of the mathematical models reported here and make refinements if necessary. Now policy planners, health system administrators and other stakeholders can begin to consider and debate the bold steps needed to make the HCV epidemic history.
Our next CATIE News bulletin focuses on work using data from British Columbia, where researchers ran simulations of programs and services that may be necessary to greatly reduce the burden of HCV infection.
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