Hep C a rare disease? Drugs from Gilead, J&J, et al. could make it so, but at a price

Gilead's Sovaldi--Courtesy of Gilead

The good news: Hepatitis C could be a rare disease just 20 years from now, thanks to stepped-up screening and new-but-pricey treatments. The bad: governments, taxpayers, private insurers and health-plan members will have to foot the bill. And it's quite a bill.

Last week, we heard that Medicare would have to pay up to $5.8 billion next year to treat just a fraction of eligible patients with the expensive new drugs--including Gilead Sciences' ($GILD) Sovaldi, which runs $84,000 for a 12-week course, and Johnson & Johnson's ($JNJ) Olysio at $66,300.

The week before, the Journal of the American Medical Association reported that treating hep C could boost health insurance premiums by $200 to $300 per person in the U.S.

But now, an Annals of Internal Medicine study shows what society could get for its billions. Widespread treatment could push hepatitis cases into the rare-disease realm, or one in about 1,500 patients. It could prevent 79,000 cases of liver cancer, more than 124,000 cases of cirrhosis and 126,500 deaths from hepatitis complications.

That's just the argument that Gilead has been making to defend Sovaldi's nosebleed pricing. And experts who weren't involved in the study back the idea, too. "Those are certainly reasonable predictions," Dr. Eugene Schiff, director of the Schiff Center for Liver diseases at the University of Miami, told HealthDay. "I don't think they're overstating the situation at all."

New drugs are delivering 90%-plus cure rates, compared with 40% to 50% with the old treatment standard, interferon. The treatment courses are shorter--12 weeks versus a year--and may grow shorter still, which could entice patients to treatment, the investigators say. New screening programs, backed by the Centers for Disease Control and Prevention in the U.S., would root out more cases of hep C, which often goes undiagnosed.

But that gets us back to the cost question. Payers are howling about the cost of treating the patients already identified. Throw in a sweeping hep C testing campaign, and the problem doubles, triples, quadruples.

More new treatments are expected to hit the U.S. market over the next 6 months, including a cocktail from AbbVie ($ABBV); a drug from Bristol-Myers Squibb ($BMS), already approved in Japan; a combo drug from Gilead; and an entrant from Merck ($MRK). The hope among payers is that competition for the market will help drive prices down.

But it might be just as likely for drugmakers to ride a wave of new diagnoses, capturing their fair shares of a growing market--despite attempts by U.S. payers to contain spending. And that means higher premiums for everybody, or so the experts are saying.

- read the HealthDay story
- here's the release