Findings from a recent study published in the journal Health Affairs have shown that treating 5 percent of all hepatitis C patients with the newest drugs, regardless of patients’ disease stage—would return substantial benefits and would be much more affordable under current financing schemes.
In the study entitled “Broad Hepatitis C Treatment Scenarios Return Substantial Health Gains, But Capacity Is A Concern”, a team of researchers from the USC Schaeffer Center for Health Policy and Economics in collaboration with other institutions, developed a discrete time Markov model to simulate the progression of a population susceptible to hepatitis C through infection and several stages of the disease, investigating the impact of new regimens and treatment strategies on population outcomes.
The study compared the cost-effectiveness of three treatment options to the current approach, or “baseline” scenario, which treats patients in the most advanced stages of hepatitis C when they may need a costly liver transplant. “We made a mistake with HIV by limiting access to treatment to just people who had AIDS, and we ended up with a virus that has been with us for decades,” said corresponding author Dana Goldman, the Schaeffer Center director and a professor at the USC School of Pharmacy and the USC Price School of Public Policy. “We didn’t initially treat HIV aggressively enough in part because the science wasn’t there to justify it. With hepatitis C, we have the science. We just need to find a way to finance it.”
The researchers found that a “treat 5 percent” approach would reduce infections from 2.7 million to 39,000 cases in 50 years, compared with the current approach, relying on older drugs, which would reduce infections to 207,000 cases in 50 years. Under the “treat 5 percent” scenario, health care expenditures would drop below the baseline’s costs within 20 years of implementation.
This study differs from previous analyses as it takes into account the variable “social value” — the benefits of treatment for the patient and society and also the profits from drug manufacturers.
In terms of patients benefits the researchers operationalized the variable as “Quality-Adjusted Life-Years”, with one QALY representing every year a drug enabled a patient to have perfect health, or to every two years that a drug enabled a patient to live half as healthy.
According to the researchers, hepatitis C treatment poses many challenging questions for the US health care system. Innovative treatments for the virus can generate tremendous value, and treating all diagnosed patients immediately reduces disease burden from hepatitis C infection most rapidly and generates the greatest social benefits, compared to other scenarios. But tightening US health care budgets and limited treatment capacity render the strategy of treating everyone at once infeasible. Thus, new treatments must instead be met over time.
- Treating all patients with the newest available drugs could bring the most social value, and it will generate up to $1.2 billion in QALYs and save up to $139 billion in health costs over a 50-year span. In 50 years there would be a drop of 1,400 cases.
- Treating the condition in advance using the newest drugs is the most expensive option and would cost about $100 billion every year following about 25 years of implementation. In 50 years, the number of hepatitis C cases would decline to 103,000 patients. This strategy would generate the smallest social value — up to $175 billion in QALYs.
- The cheapest approach is to treat 5% of all patients with hepatitis C, regardless of patients’ disease stage. With this scenario, by the eight year, net expenditures would spike to $22 billion but would then drop by year 20 to below the cost of the current treatment strategy. In QALYs, this approach could bring a social value of up to $437 billion.
Goldman noted that a usual misunderstanding is that patients with hepatitis C are drug users. Actually, as he said, these patients are baby boomers who were infected before 1992 via unsterile medical equipment or blood transfusions. Hepatitis C can also be transmitted via intravenous drug use and by HIV-infected men through sex. With the nationwide rise on heroin use, some health executives foresee a second wave of infections. Hepatitis C can remain latent for up to 15 years and then aggravate, in some cases leading to cirrhosis or death. According to federal health estimates, in the US, 5 in every 100,000 cases of hepatitis C die every year.