United States faces biggest burden of hepatitis C treatment costs before 2020

The cost of treating hepatitis C (HCV) is likely to decline dramatically over the next decade in the United States, not because of cuts in drug prices but because the population in need of treatment will shrink by 2020 as a majority of patients will already have been treated, according to research by Jagpreet Chhatwal of Massachusetts General Hospital and colleagues presented at the 2015 AASLD Liver Meeting in San Francisco last month.

HCV spending peaked in the United States in 2015 at $21 billion and will decline to around $4 billion per year in 2020, Chhatwal estimates. Approximately 80% of spending ($17 billion) in 2015 went toward direct-acting antivirals, mainly sofosbuvir (Sovaldi) and sofosbuvir/ledipasvir (Harvoni). By 2020 the cost of direct-acting antiviral treatment will fall to $2 billion due to the declining number of people in need of treatment.

The model assumes that in the period between 2003 and 2010 – prior to the introduction of direct-acting antiviral treatment – the prevalence of hepatitis C in the United States was around 2.7 million. It also assumes that the number of people with chronic hepatitis C infection will fall to around 1 million by 2020 as a result of either successful treatment or death. Of these, 70% will be unaware of their infection. Furthermore, the numbers with advanced fibrosis or cirrhosis – those in urgent need of treatment – will fall from around 400,000 in 2015 to less than 100,000 by 2020.

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