Hepatitis C is not a rare disease. It is common. As we wrote in our last summary article on Drugs for Hepatitis C (October 15, 2012), the CDC estimates that 3.25% of US adults born between 1945 and 1965 have antibodies against the virus, and many of them have chronic hepatitis C virus (HCV) infection. Chronic HCV infection can lead to cirrhosis and hepatocellular cancer, but treatment with the effective antiviral drugs that have only recently become available can eradicate the infection and prevent its progression to end-stage liver disease and death. So the stakes are high in diagnosing infection in a timely manner and treating it effectively. But the cost of the drugs that can eradicate the virus is also high. Very high.
The November 10, 2014 issue of The Medical Letter included an article on Harvoni (Gilead), a combination of 2 direct-acting antiviral agents approved by the FDA for treatment of chronic HCV genotype 1 infection (the most common type in the US). Sustained viral response rates after 12 weeks of treatment with this combination were in the range of 95-100%, even (if the drugs were continued for 24 weeks) in patients with cirrhosis. And the drugs were well tolerated; the percentages of patients who permanently discontinued treatment because of adverse effects were 0%, <1%, and 1% with 8, 12, and 24 weeks of treatment, respectively. But the wholesale acquisition cost of 12 weeks’ treatment with Harvoni is $94,500.
The next issue of The Medical Letter (February 2, 2015) will include an article on Viekira Pak (AbbVie), a combination of 3 new direct-acting antiviral drugs and ritonavir that has also been approved by the FDA for treatment of chronic HCV genotype 1 infection. Viekira Pak appears to be roughly comparable to Harvoni in efficacy, at a wholesale acquisition cost of $83,319 for 12 weeks’ treatment.
Where does that leave us? In a price war, it turns out, between the 2 largest pharmacy benefits managers in the US. AbbVie, the newcomer, moved first, making an arrangement with Express Scripts for exclusive use of Viekira Pak. Within days, Gilead responded by making a pact with CVS, described in the January 5th Wall St. Journal. The financial details of these deals have not been disclosed, and the costs to patients and their insurance companies are still unclear. For more information, watch for the February 2, 2015 issue of The Medical Letter.
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