I think solvaldi and harvoni have a success rate of almost 99% or so. Assuming when the drugs are off patent and affordable, is that a high enough success rate to eliminate Hep C as a disease, could it go the way of smallpox? Or would a minority of treatment resistant people combined with people who don’t engage in precautions to avoid spreading the disease keep it alive even with those cure rates?
Hepatitis C 'could become a rare disease by 2036
Smallpox has a vaccine that prevents infection at a high rate. That helped close the window of contracting and passing along the disease while contagious before being cured. Reducing it’s prevalence by an order of 15 times is pretty awesome though. ISTR they are still working on a vaccine.
Like Smallpox, there is no known animal reservoir for Hep C. This means that it might be possible to drive the disease into extinction.
But smallpox was difficult, and it’s an obvious terrible disease with a vaccination. Hep C is a disease you can have and not realise what your problem is.
The cost of medication for much of the world would need to be underwritten. The global estimate is 80 (64–103) million. Also, there are several genotypes, not all of which are as responsive to treatment. It would be great to knock it down hard, though. Current treatment is much easier to manage and tolerate than in the past.
The trick is screening, though. There is no vaccine (yet), so you cannot attack it via a mass vaccination program.
The best time to screen is later in life, when exposure has probably occurred but liver damage is not yet a problem. But by that point, a chronic HepC sufferer may well have infected others. So you have to screen young, and that costs money. And you have to rescreen to catch those infected after screening to reduce retransmission. You also need to commit to a very expensive course of drugs to treat sufferers.
It could be done for the treatable genotypes. But it will come down to cost, and when many (60% or more) of the infections in the western world are due to IV drug use, the political will (and thus the money) is low. In the rest of the world, better standards of medical care (transfusion screening, instrument sterilisation) would be more beneficial, and for more than just Hepatitis C infection rates.
Is this the drug our OS council was complaining last week that it costs $100,000? If so, high cost is going to make wide adoption slow and the drug company will probably fiddle with it to extend their patent.
There are cheaper (though not cheap) treatments that existed with up to 50% cure (UVL) rates prior to the new crop.
The same drugs seem to cost more in the US.
The cost will have to come down substantially for these treatments not to be restricted to the well insured, wealthy or where there is a socialised health system that picks up the bill.
It’ll take an effective vaccine to eradicate HCV. Even then it’s a long shot. We’re still struggling to eradicate polio, and currently losing ground on that fight.
I second the call for affordable HCV medication. 12% of my patients have HCV (3 new cases admitted every workday, on average), and fewer than 1% of them will get treatment during their stay with us, as we can only afford to treat those who are really not doing well with the infection. But at $1000/pill ($976 with government discounts) plus all the other costs, it takes over $1 million to treat 5 or 6 people. We don’t have the funding to treat more than a handful, and still take care of our folks with hypertension, HIV, asthma, diabetes, cancer, and rec yard brawls and shankings.
And I’ve seen treatment failures on the new meds, too. While the best studies may show 96%+ cure rates, in the real world we’re happy to hit 85%.
Some time ago interferon plus another drug were given to those with hepatitis C with symptoms. It had only a small percentage rate of success, but it was heralded as a break-through. Interferon is a powerful drug and had severe side effects. How do these new drugs work and why are they better than the previous treatment with interferon and the other drug, the name of which I do not recall?
Interferon and ribavirin. OMG, Interferon is a horrible drug! My patients would be sick for days after each weekly shot, with myalgias, arthralgias, nausea, depression. Unable to work, falling blood counts, prone to infections.
24 to 48 weeks of that, with maybe a 50% shot of a cure.
Now with the new meds, it’s a pill or two once or twice a day, for 12 to 24 weeks, with nothing like the side-effects of interferon, for 85-90% cure rates.
You can find expositions on how the new meds work easily enough on the web, so I won’t try to explain what’s been explained better by others.
The new meds are a great step forward. Except for the price.
I just had a patient (on Medicare with a supplemental policy that paid for it) on Harvoni, and it was soooooo much better than Interferon. He had a couple of days of nausea and vomiting, and his appetite was fairly nonexistent for a couple of weeks there, but other than that, nothin’. Since he had the weight to lose, it was never of great concern.
I didn’t really see him suffering much from the Hep C from a nursing standpoint, but someone must not have liked his liver panels much, because they did work to push it through his insurance with vigor, and appeal an initial denial.
For whatever reason, Gilead decided to sell them in Egypt for $10/pill.
Gilead paid $11 billion for Sovaldi, so I’m guessing they will recoup that money in a few years if they are making 5 figures in profit on each patient (if they make 50k off each patient, and that is a total guess, they will only need to treat ~200,000 patients to break even). I thought nations like India (and maybe Brazil) had determined in either their courts or legislature that if a medication is truly life saving (like an HIV drug) that they could ignore patent laws and manufacture it themselves. Are they still doing that, or does joining trade agreements prohibit that kind of behavior?
Medicare and my insurance company, and my doctor, got me three months of the Harvoni pills–haven’t received a bill from anyone accept the co-pay for the office visits to my doctor. I asked the doc why I am paying nothing for 82 of these thousand-dollar pills, and he said the insurance company and Medicare, too, I guess, feel that curing the disease is less costly than paying for a liver transplant down the road.
The three months of Harvoni seems to have gotten rid of the virus. I am due for a second blood test in another month.
I never had any ill-effects from the Hep C that I was aware of (probably contracted it 45 years ago in my young and “adventurous” days), and the Harvoni gave me absolutely no side-effects.
When my father was treated, it was just alpha interferon (non-pegelated) and had about a 16% cure rate. Didn’t work for him. When another family member was treated, it was pegelated interferon and ribavirin with a 50% rate. It worked for her. I’m really happy with 85% as the next step, and agree that the price needs to come down.
How on earth do they expect to stop western patients who cannot afford it just traveling to a country where it is a million times cheaper and purchasing a course? Or even sellers offering it to western nations via the internet, customs can’t catch everything.
Not that I wish anyone be denied access, but I just can’t see such a price disparity lasting in the face of commerce.
Strict control at source, different pill format for the low cost versions, statistical monitoring of prescriptions and treatments/cure rates.
For example, Viread (tenofovir) is an antiviral used to control both HIV and Hepatitis B. I’m familiar with it because I take it for Hepatitis B.
In the US, it costs ~USD$650 per month.
In Africa, it is delivered to Governments for HIV management at USD$30 per month. But the pills are smaller and white whereas in the West they are blue. Gilead (the manufacturer) refused to sell to the Canadian health authorities at a discounted price (probably similar to the discounts other national health services negotiate) to ensure that cross-border shipping to the US did not occur.
Do I think you could get Viread from Africa - probably. Would it be worth the risk to buy from a third hand source with no way to verify the supplied item - not to me. Could you guarantee regular supply for years? Probably not.
For Solvaldi, a three month course, it would be more appealing. But Governments that rely on the good will of firms like Gilead for cheap access to critical drugs are going to be very careful not to allow that to be jeopardized by medical tourism and cross-border shipping.
The answer is no:
Despite medication, only 34 percent of hepatitis C patients cured
The full study: