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Should Healthier Patients Be Asked To Wait To Use Costly Hepatitis C Drugs?

By Julie Appleby

March 11th, 2014, 4:16 PM

New treatments for hepatitis C that cost at least $66,000 to $84,000 may work better than older drugs, but their cost undermines their value to the health system, a panel of experts said during a daylong forum in San Francisco.

“The price makes it very hard for the health care system,” said Steve Pearson, who oversaw the meeting Monday for the California Technology Assessment Forum, a group affiliated with health insurers that holds public meetings to weigh evidence on new treatments.

The 15-member panel, which included representatives of hospitals, insurers and patient advocates, did not make specific recommendations on how to prioritize use of the drugs, which hit the market late last year. Sovaldi, made by Gilead Sciences, costs $1,000 a pill. Slightly less expensive is Olysio, made by Johnson & Johnson.

Panel members and outside experts nearly all agreed that for cost and medical reasons, not every patient with hepatitis C needs to be immediately treated with the new drugs.  An estimated 3 million Americans carry the viral infection.

“I can’t imagine how that would be feasible without bankrupting our system,” said Rena K. Fox, a professor of medicine at the University of California, San Francisco, invited by the forum to speak as an outside expert.

“What I really wish for is that we could push back on the price, rather than make patients wait. But since we don’t have the ability to change the price, we have to decide which patients are the most urgent.”

Drugmakers defend the prices citing research costs and saying the pills are curative for many patients, thus avoiding costly complications like transplants.

Both outside experts and some panel members said that waiting might be a better answer for some patients – particularly those with little or no liver damage – because additional treatments are expected to hit the market within a year.  Patients with more advanced liver damage from the virus would be treated first.

Healthier people had also waited to use the older drugs, hoping for something to come along that would have fewer side effects.

Hepatitis C is a chronic infection that can take years or decades to progress.  Over time, it can lead to cancer, cirrhosis or the need for a liver transplant.  At least 70 percent of those infected have no symptoms. It is spread mainly by intravenous drug use, but many people were unknowingly infected by poorly sterilized medical equipment and blood transfusions before widespread screening of the blood supply began in 1992.  Some may also have been infected through tattoos and piercings with contaminated needles.

But patients may not want to wait, said Ryan Clary, executive director of the National Viral Hepatitis Roundtable, a consumer group partially funded by the drug industry. Television advertisements sponsored by Gilead are encouraging people to be screened for hepatitis and to talk with their doctors about new treatment options.

“If I was hepatitis C-positive and someone said there’s this great treatment, but can you hold off because you’re healthy and it might bankrupt the system … patients don’t think like that,” said Clary, another outside expert asked to speak at the forum.

Private insurers, as well as those serving Medicaid patients, are wrestling with how to cover the new drugs. Many say they will require prior authorization and may limit coverage to the sickest patients.  Some Medicaid insurers have asked states for additional help in paying for the drugs.

A draft report prepared in advance of the San Francisco forum estimates that if every patient in California with advanced liver damage were treated, the cost would be $6.3 billion.

Recommendations that stemmed from Monday’s meeting – including the panel’s votes on a host of questions about the effectiveness of the new treatments compared with older regimens – will be released within a month.

13 Responses to “Should Healthier Patients Be Asked To Wait To Use Costly Hepatitis C Drugs?”

  1. Ted says:

    If Jonas Salk worked for Big Pharma back in 1955, polio would still be the worst disease of the post-war era because Big Pharma would make sure that the cure for polio would always be way too expensive to ever completely eradicate the disease.

  2. Dave says:

    This is what comes of unfettered free market capitalism. Greed is not good. When it comes to people’s health and lives, there should be limits how much profit Big Pharma is allowed to make. In India, the $1000 pills are going to cost $20 each. They cost about $1 each to manufacture. That doesn’t include R&D and other overhead expenses, of course, but 1000x markup is still outrageous and unacceptable.

  3. Kyle says:

    Revolutionary scientific breakthroughs come from free market capitalism… We should all try to understand that these evil big pharmaceutical companies must somehow recoup the billions of dollars they invest in R and D.

  4. Ginger says:

    I am a 50 year old female, Master’s Degree, I work fulltime, pay taxes and own property. I am a recovering addict with 13 years clean. I am truly grateful that my insurance approved the sovaldi for me, with less side effects I am still able to work, I am in the 6th week of treatment. Much cheaper than a liver transplant. I feel the treatment should be made cost effective for those who have changed their lifestyle and who are willing to to complete the treatment with 100% compliance.

  5. Otto says:

    Would it not be wiser to have a National High risk pool, funded by the insurance industry, much as re-insurance is done. Still does not solve the problem. Perhaps as NICE does, there is a cost/life year saved at $50,000 . yes breakthroughs come with the cost of both success and failure. It still remains that in the free market, nothing is free and the US still spends nearly twice as much as any other developed Nation which places us only 6th in health outcomes.

  6. Clementine L says:

    “What I really wish for is that we could push back on the price, rather than make patients wait. But since we don’t have the ability to change the price, we have to decide which patients are the most urgent.”

    Of course you can push back on the price. Just say no. If everyone said no for a while, guess what would happen to the price?

    In any case where’s the calculation of opportunity cost here? Every $ spent on Sovaldi is a $ not spent on something else. WHat about the next drug that costs three times as much again? WHat then? When are payers going to learn that they have to say no if they are ever going to be able to influence prices.

  7. Dorothy Davies says:

    I’ve had HEpC for 40 years from a blood transfusion. Liver damage has lowered my platelet count so I cannot take the standard treatments. I’m facing a risky and more costly liver transplant followed by a lifetime of anti rejection drugs. However, livers are in very short supply so I will likely die while I wait.

    I wonder how many of those who debate cost effectiveness also have the disease?

    Even more frightening is the theory that if people stop buying the drug, then the market will drive down the cost. The tragic cost will be the thousands who die waiting for the cure.

  8. KP says:

    Yes, Pharma has R&D costs but much of the riskiest research–early things that may or may not pan out — are borne by government and state universities, and then the private sector jumps in on the most promising leads. So Pharma isn’t as brave as it paints itself. And if R&D were so all-consuming, why are so many of these companies so profitable?

  9. BA says:

    I am currently on Solvadi starting week 5 Friday. I am thankful my benefits/insurance allow me to take the drug. With the extra co-pay by Gilead my out of pocket monthly expense is$5.00. I am also on interferon/ribvirin & Promacta for low platelets..I pray I’m cured!

  10. quinn says:

    In my opinion, drug makers have the cure for cancer, diabetes and heart disease. There is no doubt in my mind. They secretly hold the patents for all of these cures, yet they keep gobbling up the federal research grants year after year after year. Meanwhile, sick patients keep paying through the nose for brand-named drugs that never seem to go generic. The only reason we don’t see the compete eradication of these diseases is because, if these diseases were totally eliminated, the drug makers would go broke. Drug makers need to keep these cures a secret and keep their research teams quiet so the money keeps flowing.

  11. Shawn says:

    I’ve just completed week 2 of Sovaldi and ribivarin for 12 weeks, I think in order to be fair to patients, insurers and big Pharma, once the company has recouped their cost they would be required to only charge a 25% profit margin.

  12. zahra ahmadi says:

    Just pray … Pray it sick become cure…all muslim cristan.jwush

  13. thanbey says:

    Perhaps we can think out of the box here.

    This is NO cure for hepatitis C. It relys on the use of interferon and ribovirin (same ld same old)

    It takes a biopsy to be sure the liver is clear of the infection (and other organs) the older you are, the less likely tht there is a therapy worth the risks of taking interferon.

    Obesity, poor lifestyle choice: smoking anything, drinking alcohol, getting tattoos (especially multiple tattoos) pedicures, manicures, mother to child transmission, and anal sex are all big risk factors for the development of fibrosis and cirrhosis. And don’t forget age, it is also a risk for further fibrosis.

    Take care of yourself on every level and live with your hepatitis C. The alternative (ie interferon) can be deadly as most people live a long life and die of something else. Interferon has been shown to increase the rate of fibrosis in those who did not repond to it after one year. Minorities (who are primarily infected with genotype 1) do NOT RESPOND to hepC therapies. Note that Natalie Cole lost her kidney. Others lost their lives.