Hepatitis can be beat but at a sky-high price
Health experts have devised an aggressive plan to stamp out a viral disease that is fueling a sharp rise in liver cancer in the United States and killing 20,000 Americans per year.
Their national strategy for eliminating two types of hepatitis by 2030 hinges on persuading the federal government to purchase the rights to one or more of the costly new medications that can essentially cure hepatitis C.
That unprecedented step is one of a raft of recommendations issued last week by the National Academies of Sciences, Engineering, and Medicine. The academies’ expert panel also recommended a campaign to vaccinate all adults against hepatitis B, expanding needle exchanges for intravenous drug users and a nationwide effort to identify and treat the legions of Americans who are unknowingly infected with either strain of the virus.
All these efforts should be coordinated by a single federal office, the panel proposed. 2.7 million Americans infected
With about 2.7 million Americans infected with hepatitis C and 1.3 million people infected with hepatitis B, the stakes are high. A 2009 report estimated that the annual cost to Medicare of caring for hepatitis C patients alone would increase from $5 billion in that year to $30 billion in 2030. And that forecast didn’t include a new generation of expensive drugs.
The viruses that cause hepatitis B and C are spread through sexual contact, needle sharing and incidental exposure to infected blood. Most people with the viruses are unaware they are infected, which allows both strains to spread unchecked. Infection rates are especially high among ethnic minorities, prison populations and people who inject drugs. This last group accounts for 75 percent of the roughly 30,500 new hepatitis C infections every year in the United States.
Although infection causes no illness in its early stage, over time both strains can scar the liver, impair its function and give rise to malignancy. The nation’s unseen hepatitis epidemic is widely credited with making liver cancer the fastest growing form of malignancy and driving a dramatic increase in liver cancer deaths seen in the last decade. Hepatitis B and C also account for roughly 2,400 liver transplants each year.
The Food and Drug Administration has approved a few new antiviral medications to treat hepatitis C in the last two years. ‘A win-win for everybody’
But they haven’t been widely used for a single reason: cost. The price for a full course of treatment can range from $55,000 to $150,000. As a result, government insurance programs such as Medicaid and Medicare have limited their use to patients with late-stage disease, and private insurers have imposed onerous copayments, paperwork and delays on patients and their doctors. The panel’s experts estimated that by 2015 only 7 percent to 14 percent of patients known to be infected with hepatitis C had started treatment with the new drugs.
These drugs are among the most expensive oral medications in history, and probably will remain so until 2029, when the exclusive patent rights on the first of these new medications expires.
That’s why licensing one or more of the new-generation drugs is a key part of the panel’s plan. A licensing deal could cost taxpayers an estimated $2 billion, and the medications would then be used to treat government-insured patients whose access is now limited.
Such an arrangement could save the United States more than $8 billion by 2030, the panel estimated. Far from disadvantaging the company that agrees to a deal, the move would broaden the reach of its product to patients who would not otherwise be treated, said Rutgers University Chancellor Dr. Brian Strom, who chaired the panel.
“It’s a win-win for everybody,” Strom said Tuesday. “For the public, it’s a massive win” that would drive down the number of infected Americans spreading the virus unwittingly. And for at least one of the five drugmakers who manufacture these costly medications, striking a voluntary licensing agreement could return handsome dividends on its investment.