Hepatitis C: Cure, but at What Cost?

Paul E. Sax, MD


April 29, 2014

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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.


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