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Briefing Shed Light on the Challenges and Opportunities of HCV Treatment

Laura Joszt
New hepatitis C virus treatments may be extraordinarily effective, curing the disease in many cases, but the high cost has posed an enormous economic challenge that speakers outlined during a briefing in Washington, DC.
Patients who are not cured of HCV early on develop liver failure. Bhattacharya explained in the opening of the briefing that HCV is a common reason why people need liver transplants in the United States. The value of curing HCV as it relates to liver transplants was the focus of what Anupam Jena, MD, PhD, associate professor of health care policy at Harvard Medical School, discussed, as well as the topic of his paper in the special issue.
 
The controversy surrounding the HCV drugs is that while there is no doubt that they represent a medical breakthrough, they are so expensive.
 
“The question that always comes up is … do they offer ‘good value’?” Jena said. “Implicit in that discussion is some notion of, ‘Well, we think we know what the value is.’ What I would argue now is that we don’t have a good, solid understanding of that value.”
 
There are multiple component of the value discussion: first, that curing someone reduces their cost and saves their life; second, that since HCV is an infectious disease, curing a person lowers the likelihood of others getting infected; and third, HCV is the number one cause of liver transplant. However, there is a whole world of liver disease that has nothing to do with HCV: alcohol abuse, hereditary diseases, toxicity from drugs like Tylenol; and liver disease related to obesity.
 
Curing hepatitis C will have an impact on those other patients. If, hepatitis C prevalence has been reduced dramatically in 20 years through these expensive treatments, all those liver transplants that went to patients with end-stage liver failure through untreated HCV will now be available to go to patients with other types of liver disease.
 
“When we think about healthcare, we think about it in a silo…” Jena said. “Here’s a really unique example where treating patients with hepatitis C and curing them of the disease actually doesn’t just treat those patients themselves. It has these spillovers to patients with other forms of liver diseases. So diseases are linked in this really unique way because there is a scarce resource and that scarce resource is liver transplants.”
 
In his paper, Jena and his colleagues estimated that over the next 20 years, screening for and treating HCV with the drugs available today could spare 10,490 liver transplants.
 
However, the reality today is that most private payers and Medicaid programs have placed restrictions on HCV treatment access, explained Ryan Clary, executive director of the National Viral Hepatitis Roundtable. These restrictions are based on stage of liver disease, substance abuse and sobriety requirements, and provider limitations.
 
As a result, CMS issued guidance to state Medicaid programs to start working to expanding access to HCV treatments. However, there has been little response from the programs. There are still 40 states with liver damage restrictions. Although a few (California, Connecticut, Massachusetts, New York, Pennsylvania, and the District of Columbia) have reduced their restrictions.
 
“This is great movement forward, and it’s evidence that states actually can move to expand access,” Clary said. “In these states, this was the result of strong advocacy or threat of a lawsuit. It’s not as if states suddenly woke up one day and decided, ‘Oh, it’s time to expand our access.’”

 
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