- Jul 17, 2019
July 28th is World Hepatitis Day and in observance we want to spread awareness to our readership about this debilitating and costly health condition, as well as some newer areas of cost containment.
Hepatitis, or inflammation of the liver, can be caused by a variety of viruses, conditions and behaviors. One of the most common and expensive forms of Hepatitis is HCV or Hepatitis C. HCV is a liver infection negatively impacting both patients and self-funded health plans in part due to its highly expensive treatment options and prescription costs. Furthermore, HCV is difficult to diagnose early enough for successful intervention, and symptoms often go undetected up to the development of more serious complications or comorbidities – leaving self-funded health plan employers in an uphill battle against Hepatitis C with a strong need to do something to control the associated costs.
Health and cost outcomes for HCV are inherently dependent on individualized diagnosis, treatment, prevention, and the healthcare providers’ ability to facilitate all three factors. According to Centers for Disease Control and Prevention, “an estimated 2.4 million people in the United States are living with hepatitis C virus infection.” Hepatitis C is preventable and curable, however. The challenge lies in maximizing the value of treatment costs relative to the individual HCV case while effectively managing the infection from progressing into more serious complications.
Currently, the CDC website states that an “HCV infection becomes chronic in approximately 75%–85% of cases.” This contrasts with Acute Hepatitis C, which is a short-term version of Hepatitis C that lasts 6 months and is typically cured naturally by the body. It’s important to note that Acute Hepatitis C is not the same as Chronic Hepatitis C and that improper diagnosis / HCV management can lead to catastrophic conditions – such as Cirrhosis, Liver Cancer and Liver Failure.
Oftentimes, self-funded employers lack the necessary clinical staff and or case management resources to properly communicate educational treatment information that best addresses the risks unique to the patients attempting to manage this condition. Fortunately, self-funded employers are not alone. Innovations in prescription and treatments for HCV have developed significantly. Treatment previously consisted of months of injections that left patients feeling ill – many of whom could not continue due to health complications. According to Jeffrey S. Murray, M.D., internist at the FDA specializing in infectious diseases, “now, patients can treat their hepatitis C with only pills—drug combinations that are faster and have a higher cure rate.”
A couple of the most successful drugs developed to treat HCV were approved in December of 2013 in pill form. Namely, Sovaldi and Olysio. While Sovaldi and Olysio are prescribed separately, both drugs are part of an antiretroviral treatment plan that combines each with a host of other drugs. According to the US National Library of Medicine National Institutes of Health one pill of Sovaldi costs about $1,000 ($84,000 for the standard twelve-week plan), and Olysio is estimated to cost $23,600 for a month of treatment. The high prices, lengthy treatment and the large numbers of HCV patients make Hepatitis C one of the more debilitating conditions for a health plan and its members to endure. With a demonstrated “cure rate of over ninety percent in some populations” treated with Sovaldi, the drug’s widespread popularity comes as no surprise. In 2014, the total healthcare spend for Sovaldi was “$6.5 billion, making it the drug with most overall expenditures in the United States in 2014. Of this figure, Medicare’s share of this spending was reportedly $4.5 billion dollars.”
As listed on verywellhealth.com and ncbi.nlm.nih.gov below are a few noteworthy HCV drugs and their associated prices:
Sofosbuvir is $1,000 per day
Sofosbuvir with Ledipasvir is $1,125 a day
Mavyret is $26,400 for an 8-week course and $39,600 for a 12-week course
Vosevi is $74,760 for a 12-week course
Zepatier is $54,000 for a 12-week course
Daklinza is $25,200 for a 12-week course
Harvoni is $94,500 for a 12-week course