Making Hepatitis C History

By Robert Gish, MD

As the country continues to battle one infectious disease, health officials are simultaneously refocusing efforts to wipe another off the map thanks to medical innovation.

Getting Cured is Cost Saving

Compared to treating some COVID-19 infections, treating hepatitis C is easy. Direct-acting antivirals are taken orally and have a low risk of side effects. As a result, they are a “min mon” treatment, short for minimal monitoring. The pharmacist can dispense a full course of curative medication – either eight or 12 weeks – and send patients on their way. If they take it all, they will be cured at a 98% level or greater.

I consider curing hepatitis C a medical miracle similar to penicillin. It’s also a huge benefit to society because the cost of living with the disease is significant. Managing liver disease, getting a liver transplant and treating liver cancer are all expensive. Preventing transmission is key.

Patients used to take a three-drug cocktail to treat hepatitis C. The cost was around $180,000 to reach one cure and patients endured horrible, sometimes life-threatening side effects. About a decade ago, when direct-acting antivirals came out, the cost to treat and cure one patient dropped by about half. And it has continued to come down since. Now, a curative course runs, on average, $24,000.

At the current price point, curing hepatitis isn’t just cost effective, it’s cost saving. Recent rough estimates show society gets $1.20 worth of benefit for every $1 spent on the cure. But curing patients is only possible if they get tested and linked to care and treatment.

It Starts With Testing

Testing is quick and accurate for the HCV antibody and, before the pandemic caused a slowdown, thousands of people a day were getting tested. We must resume aggressive testing if we’re going to reach the national goal of eradicating hepatitis C by the end of this decade. We need to assure all patients who test positive are confirmed to be infected.

Populations at risk for hepatitis C may not have a primary care physician or a medical home. So, when they are seen in a clinic, it’s important to test and immediately link them to care, if needed. Every referral to another location, every extra step is an obstacle that could keep them from getting cured.

Increasing Access to Care

With the significant decrease in price, robust advocacy efforts and some legal pressure, many commercial and public insurers have dropped their barriers to access. Seven state Medicaid programs, including my home state of California, have removed all preauthorization requirements, which only serve to delay treatment. These types of policy change are necessary to help patients get cured throughout the United States.

It’s been a long time coming, but with direct-acting antivirals, we now have the ability to make hepatitis C part of history. We just need the infrastructure, investment and support to get everyone tested and, for those who need it, access to the one of the biggest medical breakthroughs ever discovered.

Robert Gish, MD, is the medical director of the Hepatitis B Foundation and a member of the Alliance for Patient Access’ Hepatitis Therapy Access Physicians Working Group.

Breakthrough, an IfPA blog series, offers health care providers a voice in the ever-growing conversation about innovation and value.

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