Treatment with New Hepatitis C Drugs Could Generate Billions in Savings Over 20 Years

Treatment with New Hepatitis C Drugs Could Generate Billions in Savings Over 20 Years

New hepatitis C drugs cure the disease in a vast majority of patients, but the heavy price tag discourages their use. The debate on whether or not we can afford the new hepatitis treatment has been raging since the drugs’ approval, but now, a series of studies clearly shows that we cannot afford not to use them, modeling savings in the billions.

The three studies — funded by the pharmaceutical company AbbVie — investigated different aspects of costs and treatment policy. They were all published in a special issue of the American Journal of Managed Care, dedicated to the hepatitis C virus (HCV).

Darius Lakdawalla, a Quintiles Professor of Pharmaceutical Development and Regulatory Innovation at the University of Southern California (USC) Schaeffer Center for Health Policy and Economics, and a co-founder of Precision Health Economics — a health economy analytical firm known for its academic expertise  — took on a central role in the studies, working together with teams from a range of other U.S. academic institutions.

“Many policymakers have focused on what they see as a high price for three months of therapy, but the value of curing hepatitis C lasts a lifetime,” Lakdawalla said in an USC news release written by Emily Gersema.

Studies have shown that from 13 to 36 percent of the millions of chronic hepatitis C patients in the U.S. have received treatment. The numbers of people who completed the treatment are even less, leading to a progression of disease that might end up in a liver transplant — a costly solution that is not always available to those who might need it.

In one study, titled Costs and Spillover Effects of Private Insurers’ Coverage of Hepatitis C Treatment, the research team, including Lakdawalla, showed that if private insurers would expand their coverage to include hepatitis patients who have not yet progressed to more advanced disease stages, private payers would have increased short-term costs, but savings over a 20-year period would amount to $10-$14 billion after treatment costs.

Moreover, the analysis showed that using the current approach, costs largely end up in Medicare expenses, or are transferred to other private insurers a patient might switch to at a later time. A switch in policy, the study demonstrated, would lead to Medicare savings of $0.3 billion to $0.7 billion in five years, and increase to $4 billion to $11 billion over a 20-year period.

Another study, The Wider Public Health Value of HCV Treatment Accrued by Liver Transplant Recipients— led by Harvard Medical School researcher Anupam Jena — looked at early and late treatment costs. The team found that systematic screening for hepatitis C, followed by early treatment, would save an astonishing 10,490 liver transplants in hepatitis C patients from 2015 to 2035.

Such savings would benefit an estimated 7,321 patients with other types of end-stage liver disease, and 3,169 hepatitis patients not cured with medical approaches. This, the team calculated, would sum up to an additional 52,700 and 22,800 life-years in these two groups, respectively.

The third study, Value of Expanding HCV Screening and Treatment Policies in the United States, also explored the effects of screening and expanded treatment by modeling three different scenarios. The study focused on a 20-year period and found that if all individuals in the population were screened and treated in the late disease stages, it would generate $0.68 billion in social value.

Instead, if the screened individuals are offered care also in early disease stages, it could generate $824 billion in social value, calculated as the value of improved survival with better health (quality-adjusted life-years, or QALYs), and reduced disease transmission, after reducing the total amount with costs for screening and treatment.

The special issue included a commentary by Lakdawalla — Does Patient Cost Sharing for HCV Drugs Make Sense? — criticizing current insurance arrangements in which patients need to share the cost of their treatment. He underscored the inability of hepatitis patients to deal with such economic burden, since their condition itself most often puts them in a difficult financial situation, supporting his claims by research showing lower adherence to treatment when patients need to bear part of the costs.

A problem with current arrangements is that private insurers hesitate to invest a large sum in a patient who might later change their insurance provider. According to Lakdawalla, it is up to policymakers to solve the situation.

“Innovative policies that allow private insurers to harvest the savings they create — even when they accrue to other insurers down the road — may represent a critical strategy to help society unlock the value of cures for hepatitis C and other diseases,” he concluded.

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