New hepatitis C treatments cost-effective, may exceed insurers' willingness to pay

New therapies for hepatitis C are cost-effective for some patients, according to a study, but high costs may become a barrier to use.

Sofosbuvir can be used in combination with ribavirin to treat chronic hepatitis C genotype 2 or 3 without interferon, with cure rates greater than with the previous standard of care without the fear of toxicity, the study states. While it may be worth its extra cost when compared with the combination of pegylated interferon and ribavirin for some patients, it costs approximately $28,000 for 4 weeks of treatment, which may be too expensive for patients on publicly funded health insurance programs, stated the report, which was published March 30 by Annals of Internal Medicine. In treatment-naive noncirrhotic patients, the incremental cost-effectiveness ratio would be well over $100,000 per quality-adjusted life-year (QALY), the authors found.

Researchers reported 2 reasons that sofosbuvir-based therapy may not be cost-effective for certain patients. First, the relative benefits of interferon-free treatment are reduced because pegylated interferon-ribavirin offers about 80% efficacy. Pegylated interferon-ribavirin is not an effective option for treatment-experienced patients, and the incremental benefits of sofosbuvir are larger than for no treatment, resulting in incremental cost-effectiveness ratios of less than $100,000 per QALY.

Second, hepatitis C-infected patients are at low risk for death from hepatitis C until they develop cirrhosis, and not all develop cirrhosis. As a result, the benefits of interferon-free therapy do not translate directly into substantial increases in life expectancy or quality-adjusted life expectancy in noncirrhotic patients.

An accompanying editorial suggested that cost may be the only factor preventing the eradication of hepatitis C. The editorialists wrote that prioritizing treatment for those at highest risk for complications of hepatitis C infection makes sense in a cost-constrained environment, and a majority of state Medicaid programs and third-party payers have adopted this approach.

“Of note, in all 3 cost-effectiveness analyses, the drug prices were the most important variable driving cost-effectiveness,” the editorial states. “Therefore, the simplest solution would be to reduce the price of the new drugs. Hopefully, in a free market environment, competition will eventually drive down costs. However, this will happen too late for some patients, and costs will remain prohibitively expensive in some settings.”

In related news, the FDA warned that sofosbuvir (Solvadi) and ledipasvir/sofosbuvir fixed-dose combination (Harvoni) have been associated with cases of symptomatic bradycardia, including 1 death, when co-administered with amiodarone and another direct-acting antiviral such as the investigational drug daclatasvir or simeprevir (Olysio). The drugs should not be prescribed together, but if doing so is unavoidable, heart monitoring in an inpatient hospital setting for the first 48 hours is recommended.

ACP Internist covered new therapies for hepatitis C in its January 2015 issue.