Novel HCV therapies found cost effective, with caveats

The recent development and widespread use of well-tolerated and highly efficacious direct-acting antiviral agents (DAAs) represent a paradigm shift in which the retail cost of treatment is now the most significant barrier to hepatitis C virus (HCV) eradication. While we have begun to learn the medical value of curing HCV in the context of the staggering burden of chronic liver disease, much less is known about the economic value of the cost of therapy. There has been swift public outcry over the $1,000 per pill price tag of sofosbuvir, and demand for the medications remains high as nearly all HCV-infected patients are now treatment eligible. Despite the high cost, these two studies collectively demonstrate a favorable incremental cost-effectiveness ratio per adjusted life-year relative to interferon-containing regimens in most patients with HCV: genotype 1, treatment-experienced, and cirrhotics.

These studies illustrate the paradox at the crux of the issue: How can the novel HCV therapies be both cost effective for most HCV patients but simultaneously unaffordable for payers? Although the price of achieving a sustained virologic response (SVR) is reduced with the DAA regimens, the cost of treating all infected patients in the United States could exceed $300 billion, which greatly outweighs the short-term cost of the annual HCV-related burden (approximately $6.5 billion [Hepatology 2013;57:2164-70]).

Treatment of other chronic illness such as HIV may incur greater costs but are distributed over a lifetime. Additionally, the current payers may not be the recipients of the downstream financial benefits of prevented liver-related outcomes. Ultimately, value depends on perspective; payers may balk at the price for the same cure that our patients consider invaluable.

Dr. J.P. Norvell is assistant professor of medicine, Emory University, Atlanta. He has been a consultant to Gilead Sciences.