The high price on one hand and the urgency to provide treatment for chronic Hepatitis C Virus (HCV) infection on the other has become a dilemma for healthcare professionals, hospital representatives, insurers, and patient advocates including Medicaid as to how to go about administering these medicines. This was the agenda at a recent meeting for the California Technology Assessment Forum (CATF), a group affiliated with health insurers conducting meetings in the wake of advances made in treatment options. It was estimated that any line of treatment carried on with these two drugs could cost as much as $66,000 to $84,000 in one course — an amount that would make the entire health insurance system go bankrupt.
Finding a feasible solution to this issue was no less a challenge for the 15 member panel who convened the meeting. It was agreed upon however, that with the drug makers having defended their pricing, owing to the efficacy and potential against chronic HCV, there is currently no scope of a possible price reduction. According to Rena K. Fox, a professor of medicine at the University of California, San Francisco, “What I really wish for is that we could push back on the price, rather than make patients wait. But since we don’t have the ability to change the price, we have to decide which patients are the most urgent.” Hence, in a country where almost 3 to 5 million people are diagnosed by HCV every year, it became necessary to prioritize the needs of each patient by assessing the severity of infection.
HCV infections take a long time to diagnose, sometimes years or even decades, thanks to the disease’s non-specific symptoms. Hence, medical experts believe that the best course of action will be to treat those with a considerable amount of liver damage (pertaining to cirrhosis, fibrosis or cancer) first, in comparison to recently diagnosed patients with little or no liver damage at all.
Assessing the situation from an ethical point of view, Ryan Clary, executive director of the National Viral Hepatitis Roundtable, a consumer group partially funded by the drug industry, said that, “If I was hepatitis C-positive and someone said there’s this great treatment, but can you hold off because you’re healthy and it might bankrupt the system … patients don’t think like that!” But one does not have much of an option, given that the total estimated cost of treating every HCV infected patient in California alone comes up to $6.3 billion (according to a draft report prepared in advance for the meeting). Even Medicaid insurers are worried as to how to cover up for the drugs for those in need immediately, and have asked the states for additional help.
Another major cause of concern would be marketing these drugs overseas, especially to the developing and third world countries where rates of infection with HCV are much higher.
A report with the committee’s recommendation will be published within a month, according to a report by the Washington Post (dated march 12, 2014).