Findings from a recent analysis conducted at the University of California San Francisco show the worth of providing patients with costly drugs that can treat their hepatitis C much earlier than some insurance companies are willing to allow. The findings were surprising, as the drugs can cost up to $100,000 over a full course of hepatitis C treatment.
Researchers modeled the effects of treating hepatitis C early versus late in its development, and factored in the long-term clinical cost of postponed hepatitis C treatment. The results revealed that the savings, combined with patients’ improvement in quality of life, were enough under the existing standards to justify the drugs’ use at early stages of liver fibrosis, and they concluded that their use is cost-effective.
Cost-effectiveness analysis (CEA) is a form of economic analysis that compares the relative costs and outcomes (effects) of two or more courses of action. Cost-effectiveness analysis is often used in the field of health services to determine social benefit.
About 3.2 million people in the U.S. have the hepatitis C virus, most of them infected by blood transfusions before the testing of blood donors became available in 1992. More recent infections are usually attributed to intravenous drug use. About 75% to 85% of these patients end up developing chronic hepatitis C, which can lead to conditions like liver cancer and cirrhosis, or scarring of the liver. Early treatment can prevent these complications, and the costly treatments are typically given to patients, but only after the virus has sufficiently injured the liver.
Liver damage caused by hepatitis C is classified in terms of increasing severity from zero to four. In this study, researchers conducted a comparative analysis of the costs of providing sofosbuvir-ledipasvir (Harvoni) treatment to patients at all stages of liver fibrosis, compared with the cost of waiting until stages three or four. The results revealed that with current drug prices, providing treatment to half of the patients now known to be infected but not yet under treatment would cost about $53 billion over five years, whereas providing treatment exclusively to those at stages three and four would cost $30 billion.
However, providing patients with early treatment would avoid the costs associated with treating long-term infection. The researchers projected the lifetime healthcare savings of treating all stages of liver fibrosis to be $3.3 billion.
“The budgetary implications of widespread treatment are quite large at current drug prices,” James G. Kahn, MD, MPH, a professor in the UCSF Department of Epidemiology, Biostatics and Medicine, said in a recent news release. “However, these costs are time-limited, and they are lower than some other treatments that are less effective. In the U.S., we spend more than $140 billion a year treating cancer, often with less health benefit than is provided by the new hepatitis C treatments.”
According to the researchers, it was important to widen the debate beyond cost-effectiveness, to include drugs cost. “The benefits of early therapy are significant, since it increases the number of healthy life years for patients and decreases their chances of getting serious liver diseases, like liver failure and liver cancer,” said Harinder Chahal, PharmD, MSc, an assistant adjunct professor in the UCSF Department of Clinical Pharmacy. “But the current prices are keeping early treatment out of reach for many patients, and this needs to be addressed.”