Could hepatitis C eventually be a rare disease?
By David Templeton, Pittsburgh Post-Gazette | |
McClatchy-Tribune Information Services |
She is one of the lucky few. She is cured, with no detectable virus in her blood since July.
But it is a medical roller-coaster ride for the 4 million Americans and 180 million people worldwide with hepatitis C.
The latest issue involves two new antiviral medications that can cure a patient in 12 weeks and one expected soon to be available once the
A 12-week treatment regimen with one of two drugs costs
The major step forward in treating the infection must be weighed against the drugs' costs that pose a "potential threat to the viability of the U.S. health-care system," states proposed guidelines for use of the drugs outlined last week in the
One in 100 Americans has hepatitis C, with 80 percent of the cases infecting baby boomers. Many contracted the disease decades ago when blood transfusions were not screened for the virus. The infection also can be transmitted through intravenous drug use and sexual transmission.
"Actually, I felt good," she said. "A lot of patients get discoloration, but I wasn't yellow. I did not lose weight. I really looked healthy."
Soon after diagnosis, she was placed on the traditional course of peginterferon and ribavirin, which requires about a year of treatment to produce a cure about 50 percent of the time but with adverse side effects. The drugs did not work for
But back pain in
So she received insurance approval for the expensive dual-drug combination of sofosbuvir and simeprevir, which she took May through July, with a
"If you already went through a transplant, you don't want anything to happen to the new liver,"
The liver is the body's largest organ, with more than 500 functions, said
In 2007, the death rate from hepatitis C began exceeding that of human immunodeficiency virus infections in
Screening allows for earlier recognition of symptoms and allows for lifestyle changes, including dietary changes and abstinence from alcohol,
"When you look at an area like
"It is important that the average person not be afraid or ashamed to be screened because there is better recognition of the problem, and we can address it before we get to a point where the situation is irretrievable,"
"A lot of drugs are really expensive, but they are not used for conditions as common as hepatitis C," he said. "These decisions about what drugs to cover and what to screen for are extremely difficult decisions."
For now, many of those decisions are made by
"But not everyone who has hepatitis C will end up with a transplant or cirrhosis, and we don't know how to exactly predict who those people will be,"
One issue being debated is the cost to research, develop, test and manufacture the drugs. That question arose in recent weeks when the pharmaceutical company Gilead announced agreements to sell generic sofosbuvir overseas at the dramatically reduced price.
Gilead is seeking
The pharmaceutical company said a regimen of Solvadi (sofosbuvir) "is the most cost-effective treatment option for patients" infected with the primary type of hepatitis C because of fewer treatment failures and adverse events, along with averted liver-disease costs. Earlier use of Solvadi, it says, "yields better health and economic outcomes compared with later initiation," by reducing such complications as cancer and the "downstream costs associated with advancing [liver] disease."
In the JAMA report, the
"Unless the prices of the new drugs decrease, public and private insurers face an untenable spike in short-term costs and will be forced to develop stringent patient eligibility criteria as the only way to manage the tension between access and affordability," said
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