A Revolution in Treatment for Hepatitis C Infection: Mitigating the Budgetary Impact
(2016; 3 pages)

Marseille E, Kahn JG (2016) A Revolution in Treatment for Hepatitis C Infection: Mitigating the Budgetary Impact. PLoS Med 13(5): e1002031. doi:10.1371/journal.pmed.1002031


The new generation of direct-acting antiviral drugs for hepatitis C (HCV) are extraordinarily effective, safe and well tolerated. With a relatively short 12-week course of treatment costing approximately US$84,000 in the United States, they are also extraordinarily costly.

In their study in PLOS Medicine, Suzanne Hill and colleagues address important economic implications of the new HCV therapies in 26 Organisation for Economic Cooperation and Development (OECD) member countries plus four low- and middle-income countries (LMICs). Given medicine prices specific to each country and the recommended 12-week treatment, the authors calculated total drug costs, which they compared with the total pharmaceutical expenditure (TPE) and the average annual wage in each country. By these measures of affordability, the authors argue that the new drug regimens ". . .threaten the sustainability of health systems in many countries and prevent large scale provision of treatment." They call for fairer prices that would allow countries to invest in more treatment and thus lower the burden of HCV.

Lower prices would ease the budgetary impact of these drugs and accelerate access. However, we believe that even with the current price structure, in each country the budgetary impact need not be as severe as suggested. In this Perspective, we compare the history of the pricing and availability of antiviral therapy for HIV with that of HCV. Elucidating points of similarity, and particularly differences, may aid in understanding the challenges and opportunities associated with the HCV therapies.

Both HIV anti-retroviral therapy (ART) and the new HCV therapies are highly effective, revolutionizing the responses to these diseases. While no cure, ART famously had the “Lazarus effect” of bringing patients back from the brink of death. With subsequent refinement of the regimens, patients may live as long as their HIV-negative counterparts and with a tolerable side-effect profile. Similarly, the new generation of HCV treatments are very effective, with cure rates of 95%. The other similarity is the very high price. At an annual cost of US$12,000 in the early days of ART, these prices ensured that ART could not be implemented at scale in LMICs, even with assistance from donors. Similarly, at a list price for HCV therapies of about US $84,000 in high-income countries, the onerous short-term budgetary impact guarantees that the new therapies will not be immediately available to all those who might benefit in rich countries, let alone LMICs. But here the similarities end, and the differences are more illuminating.

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