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Who Should Get Pricey Hepatitis C Drugs?

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Is There Harm In Waiting?

Waiting is not unusual for hepatitis patients. In the past, many chose to delay treatment because the available options were problematic. Older regimens were complex to administer, had to be taken for longer periods and were less effective. So there is pent-up demand for the new drugs, although some may still want to wait for interferon-free alternatives. 

Adding to the controversy over the prices of Sovaldi and Olysio, the panel convened by the two medical societies had recommended that some patients who can't take interferon be treated with a combination of those two drugs — nearly doubling the cost. That combination was not approved by the Food and Drug Administration, although doctors can still prescribe it. The combination has been tested on only a small sample of patients. “There's a big temptation to treat them now," said Fox of the VA panel. "But we have to remain evidence-based."

With a slow-progressing disease, waiting until those studies are completed — or until there are other interferon-free regimens — might be a good option for such patients, Fox said.

For every 100 patients chronically infected with the virus, 60 to 70 will develop liver disease, according to projections cited in a report prepared for the California Technology Assessment Forum. Over 20 years or more, an expected 5 to 20 will develop cirrhosis, which is irreversible scarring of the liver. One to five of those would die of cirrhosis or liver cancer. 

Asking Patients To Delay Treatment

Experts note that it’s highly unusual to ask patients to wait for a treatment already on the market.

“When you think of diabetes, high blood pressure, cancer or other conditions, there aren’t many where there is a serious discussion of whether or not treatment should be given”— and usually that’s because of a safety issue, said David Thomas, another member of the medical societies’ panel.

“There’s no safety issue, so ‘Does it cost too much’ is the only question left,” said Thomas, director of the infectious diseases division at Johns Hopkins University School of Medicine.

Speaking for himself, rather than the panel, he said that cost questions need to be debated “with all the vested parties at the table, not just the doctor sitting down with a patient.”

Yet doctors are increasingly being asked to think about cost — at the risk of a loss of trust by their patients, said NYU’S Caplan.

“That’s a shot directly across the bow of the traditional notion that my physician is my advocate, that they look out for me … and don’t worry about the national debt or the fact that Medicare will go broke in 20 years,” he said. “They worry about me.”

Fri, May 02 2014

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