New Hepatitis C Regimens: Too Costly to Use?

When it comes to treating hepatitis C, "(t)he challenge facing practitioners at present is the difficult decision of weighing the urgency to treat patients with currently available protease inhibitor-based triple therapy against the risks of waiting for the more potent, better tolerated novel agents," wrote infectious disease specialist Arun Jesudian MD in Rheumatology Network barely a year ago, just before the US Food and Drug Administration approved a raft of new options that appear to cure hepatitis C.

These combinations "truly (seem) to eradicate the virus, at least as far as we know at present," writes another infectious disease expert, Rodger D. MacArthur MD of Wayne State University Medical Center, in a recent review. But insurers are balking at the cost.

A 12-week regimen of sofosbuvir, the newly approved option that can treat patients with rheumatologic diseases unable to use interferon-based regimens, costs $84,000 (or $1,000 a day), according to its manufacturer, Gilead Sciences, Inc. Adding in ribavirin for an effective cure, MacArthur estimates, brings the cost per treatment course above $150,000.

That said, in Is Treating Hepatitis C Cost-Effective?, he cites evidence that a 24-week regimen of sofosbuvir plus ribavirin costs $17,000 per quality-adjusted life year (QALY), well below the lower limit of $50,000per QALY at which most health-services research judges a treatment cost-effective.

The pivotal question now, he observes, is which patients to treat quickly, and for whom to defer treatment awaiting even better options. So even with the advantage of newly approved and effective treatments, the challenge for clinicians faced with hepatitis C appears to remain the same.