COMMENTARY

Hepatitis C: Cure, but at What Cost?

Paul E. Sax, MD

Disclosures

April 29, 2014

This feature requires the newest version of Flash. You can download it here.

Hello. This is Dr. Paul Sax from the Brigham and Women's Hospital and Harvard Medical School.

As you're probably aware, this has been a very interesting few weeks for hepatitis C treatment. We had the Liver Congress in Europe (the European Association for the Study of the Liver, or EASL), where we saw many exciting and promising treatments -- all interferon-free and really raising the bar for success.

Published in the New England Journal of Medicine were some of the papers presented there, including the phase 3 data on sofosbuvir plus ledipasvir as a single pill used as an 8-week successful treatment with a 95% cure rate.[1] Also in the New England Journal of Medicine was a publication on a different interferon-free approach and one we've seen before. This was in cirrhotic patients who were difficult to treat, using 3 directly active agents, none of which were sofosbuvir -- a protease inhibitor, a nucleotide nonstructural 5A inhibitor, and a nonnucleoside polymerase inhibitor. Again, they showed a 95% cure rate after a 12-week course.[2]

At the same time, we have the first World Health Organization (WHO) guidelines about evaluation and management of hepatitis C.[3] Importantly, these WHO guidelines raise the difficult issues of resources available to treat people for hepatitis C. Right now, these extraordinary treatments are extraordinarily expensive.

Anyone who has been treating hepatitis C for the past decade or so and has experienced what it's like to treat people with our newest drugs realizes that, finally, we've made it to an era when interferon-free treatments are available. And, arguably, the best treatment for genotype 1 hepatitis C virus -- sofosbuvir plus simeprevir for 12 weeks -- is extremely well tolerated and is probably going to be more than 90% successful. But it costs about $1800 a day. So we are in this uncomfortable position where we have this extraordinary advance in treatment, both in efficacy and tolerability, and at the same time this very high cost.[4]

How payers, patients, clinicians, and policy makers are going to handle this remains an open question -- one that's debated on a day-to-day basis. Stay tuned. Certainly, more choice will likely mean greater options both in terms of different regimens to choose as well as perhaps lower costs. This enormous progress is something that I am hopeful we'll all be able to take advantage of very soon.

Thank you very much.

Comments

3090D553-9492-4563-8681-AD288FA52ACE
Comments on Medscape are moderated and should be professional in tone and on topic. You must declare any conflicts of interest related to your comments and responses. Please see our Commenting Guide for further information. We reserve the right to remove posts at our sole discretion.
Post as:

processing....