Sunday, October 12, 2014

Is Hepatitis C Treatment Cost-effective?

One catch phrase in health care reform is cost-effectiveness.  To paraphrase, this label means that a medical treatment is worth the price.  For example, influenza vaccine, or ‘flu shot’, is effective in reducing the risk of influenza infection.  If the price of each vaccine were $1,000, it would still be medically effective, but it would no longer be cost-effective considering that over 100 million Americans need the vaccine.  Society could not bear this cost as it would drain too many resources from other worthy health endeavors.  Economists argue as to which price point determines cost-effectiveness for specific medical treatments.  As you might expect, insurance companies and pharmaceutical companies might reach different conclusions when the each perform a cost-benefit analysis. 

Remember, it’s not just cost we’re focusing on here, but also effectiveness.  If a medicine is dirt cheap, but it doesn’t work, it’s not cost-effective.  Get it?

Pharmaceutical companies who are launching extremely expensive medicines often boast about the medical benefits while they ignore the cost factor entirely.  We see this phenomenon regularly when the pharm reps come to our office or we are listening to a paid speaker.

Understandably, when expensive medical care is being paid for by a third party, patients and their families are not considering cost-effectiveness.  They are focused on their own health and welfare.  If the doctor advises that our mom needs chemo, we’re not wondering if the cost would be a fair allocation of societal resources. 

A new hepatitis C (HCV) drug, Sovaldi, has recently been launched.  The 12 week course of treatment costs $84,000, or $1,000 a pill.  This bargain doesn’t include the costs of other drugs that are taken with Sovaldi as part of the treatment program.   The cost of curing HCV, a worthy objective, approaches $200,000 including the costs of medicines, physician services and laboratory and radiology testing.  Assuming that there are over 3 million Americans who are infected with HCV, the costs for curing them all approaches $300 billion.   That’s billion with a ‘B’.

Electron Micrograph of HCV

Consider these facts before deciding if hepatitis C treatment is cost-effective.
  • Most patients with HCV feel well.
  • Most patients with HCV are not aware that they are infected.
  • The majority of patients with HCV will not develop cirrhosis or other serious complications of the disease.
  • Many HCV patients who are ‘cured’ of the virus would never have developed any health issues.  They were silently infected.
Here’s what’s needed.
  • Identifying HCV patients who are destined to develop severe complications.
  • Proof that treating these patients changes the course of their disease.
  • HCV treatment that is cost-effective.
TV or print ads about HCV treatment suggest that you ‘talk with your doctor to see if the drug is right for you’,   When you do so, ask for the evidence that the treatment will allow you to live longer or live better.  Clearing your body of HCV sounds like a triumph and is marketed as such, but this might not change your life at all.

Information is power.  I wish there was some way this post could go viral.


Anonymous said...
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Anonymous said...

You do realize Harvoni was approved on 10/12/14?

Michael Kirsch, M.D. said...

Yes, of course. And there will be more to follow. I don't think that this changes the point of the post. Thanks for the comment.

Barbara said...

๐Ÿ˜Š๐Ÿ‘๐Ÿ‘Reminds me of an old adage - if it ain't broke, don't fix it. If it does no harm, why treat it?

Suziq38 said...

Thank you for your post.
If I ever get Hep C, I will remember your post.
I also worked for a pharmaceutical company in my youth, so I know what you mean.
Drugs that work are big business, and the pharmaceutical companies will sell it no matter what the cost is.

Anonymous said...

It seems like there is a black hole. I wish I knew how infectious disease and GI specialists are handling this issue? The latest FDA approved drug is even more (96K for 12 weeks of therapy). I strongly believe in cost effectiveness and the "greatest good for the greatest number". What criteria do MDs use to decide who they will treat and what oversight is there over their decision making when it has such a significant impact on the country's health care expenditures? I believe that physicians in general and specifically, MD leadership, owe the public greater transparency.

Michael Kirsch, M.D. said...

Very little oversight since neither the physician nor the patient is spending their own money. The emphasis is on safety and effectiveness, not cost.

Jef Witten said...

isn't hcv the leading cause of liver transplants in usa today. I know the stats for developing complications from decades of living with hcv' Is a roll of the dice worth not spending the money on treatment?

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