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Who Should Get Pricey Hepatitis C Drugs?

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As they draft their guidelines, many are considering recommendations from expert groups.

Early this year, a panel from the American Association for the Study of Liver Diseases and the Infectious Diseases Society of America said the new drugs should be the preferred treatments for most of those infected with virus. The 28-member group, a majority of whom received drug industry financing directly or through their research institutions, did not set any criteria for which patients should get the treatment first.

“We just put down the best regimen for the individual,” said Gary Davis, a hepatitis expert and panel co-chairman. “We recognize cost issues are really important, but we are clinicians, not the people who should be addressing that.”

But in April, a panel for the Department of Veterans Affairs— none of whose members reported financial ties with the drug industry —offered a different take:  It suggested doctors use the drugs mostly for patients with advanced liver disease, including those awaiting transplants. The VA panel said most patients at earlier stages of the disease should consider waiting for drugs now in development that may prove superior. Analysts expect those drugs to be available within the next year or two.

Sovaldi and Olysio “should be used because they have a high clinical benefit, but not everyone needs to be treated immediately,” said Rena Fox, a VA panelist and professor of medicine at the University of California at San Francisco.

Recommendations to prioritize treatment for those with advanced liver disease were also made by the California Technology Assessment Forum, a panel sponsored by the Blue Shield of California Foundation that advises insurers, providers and patients.

They noted that drugs expected out as early as this fall may prove superior because they will not require the use of interferon, a drug that can have debilitating side effects.

Even so, Ryan Clary, executive director of the National Viral Hepatitis Roundtable, a patient group, lambastes such limits as "absolutely, rationing." His group, which receives funding from the drug industry, wants the treatments to be broadly available.

"There are plenty of reasons a person with hepatitis C would like to have the virus out of their body," he said. "To say, 'We want you to hold off until you start to get sick,' is really problematic."

Fri, May 02 2014

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