Welcome back. In this edition of the Corner I wanted to provide a recent update relating to screening for hepatitis C.
I am sure everyone is aware of the advancements in treatment of hepatitis C that started back in 2014 with products like Sovaldi® and Olysio®.
Not only were these medications game changers from both an efficacy and tolerability standpoint, but they also came at a substantial cost ranging from $90,000 or more depending on the specific genotype and stage of liver damage. In the following years, many products have come to market including: Daklinza®, Epclusa®, Harvoni®, Mavyret®, Technivie®, Viekira®, Vosevi®, and others. While some of these products are still available today, others are not due to saturation of the market and the availability of more cost-effective products.
In 2013, the US Preventative Services Task Force (USPSTF) recommended screening adults who were born between 1945 and 1965 for hepatitis C. This was based on the premise that this age group had the highest prevalence of infection due to a variety of reasons.
This recommendation stems from the incidence of infection being higher in those who are younger and/or are involved with IV drug use. Furthermore, the thought is that even though these individuals may be asymptomatic in many cases, identifying (and potentially treating) them earlier will result in a reduction of complications such as cirrhosis or hepatocellular carcinoma (liver cancer).
Given the fact this recommendation has been given a “B” grade-rating by the USPSTF, it now falls under the requirements of the Affordable Care Act (ACA). Currently the ACA requires that non-grandfathered health plans cover preventive services deemed with either an “A” or “B” rating with no cost sharing. The rating relates to the screening for hepatitis C only. Medications used in the treatment of the condition are not directly affected by this updated recommendation.
From a medication standpoint, more screening will inevitably lead to more treatment for hepatitis C. With medications such as Mavyret®, Harvoni®, and Epclusa®, it may be feasible to treat some patients with hepatitis C for under $30,000 for the entire course. While not inexpensive, the costs for these medications have definitely come down since their introduction back in 2014. It is also important to mention that the screening and treatment are just a few pieces to eliminating hepatitis C as a public health threat. Along with these measures, additional strategies must also be deployed to address any underlying causes of hepatitis C such as IV drug use or other behaviors that have been shown to spread the disease.
Thanks for stopping in and see you next month.