Patients First: Price Wars, Treatment Outcomes, Longevity Alan Franciscus, Editor-in-Chief

This month’s Patients First is full of good news (for a change) for patients.  The HCV price war between Gilead and AbbVie is lowering drug prices, which will hopefully equal more treatment access for patients.  Curing hepatitis C improves emotional well-being and improves long-term survival in people with cirrhosis.

Price Cuts/Value
Since AbbVie’s approval  of Viekira Pak to treat HCV genotype 1 there have been many negotiations between the various insurance companies and pharmacies for price reductions.  This has led to steep price cuts.  The California Technology Assessment Forum (CTAF) met earlier this year and voted that Harvoni represented a “LOW” health system value based on the price of $95,000 for the 12 week price.  CTAF reasoned that this would increase Medicaid costs by over 5% in a single year if all patients with HCV were treated.  Now, that the price is in the $34,000 to $42,000 range for the average course of therapy, CTAF has changed its assessment to “HIGH” health system value.  This is good news for the state Medicaid budgets and patients.  Hopefully, this will translate  into treatment for more patients.
Treatment: Mental and Physical Health Outcomes
The Chronic Hepatitis Cohort Study (CheCS) is a large ongoing national study.  Electronic health records from four sites for the period between 1/1/2006 and 12/31/2010 were provided for this study.   Overall 4,781 surveys were completed.  Of these, the average age was 57 yo, 71% were white, 57% male, 51% had past injection drug use, 34% were current smokers, and 18% abused alcohol in the past year.  In regards to treatment, 47% had been treated previously and 15% had achieved SVR12.

Overall, about 30% met the criteria for depression—this compared to 9% of the general population who have depression.  About 25% of those with hepatitis C had poor physical health—this is a very large number for any disease condition.

The article discussed how having depression and being on interferon-based therapy affected many areas of life more than interferon-free therapies, “However, achieving SVR was associated with improved emotional well-being—at least the absence of depression—in these patients.  Conversely, there appeared to be little physical or mental health benefit for those who did not achieve SVR, for whatever reason, after starting antiviral therapy.”
Curing HCV = Living Longer
A recent study from the Netherlands sheds some very positive light on how being cured affects long-term survival. The researchers analyzed data between 1990 and 2003 from 5 hepatology centers in Europe and Canada.  The patients were treated, and were followed beginning 24 weeks after treatment ended.  Follow-up was competed in 454 patients—median age was 48, most were male (70%) and 36% patients were cured.  The median follow-up period was 8.4 years (6.4 to 11.4 years).  Importantly, all of the patients had advanced fibrosis.

The 10-year survival of the people who were cured was 91%, which did not differ from the age- and sex-match of the general population – in other words being cured of hepatitis C and advanced fibrosis meant that people would live as long as someone without hepatitis C—that’s pretty important and impressive.

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