What is Hepatitis C Virus (HCV) Infection?

Hepatitis C virus (HCV) primarily affects the liver causing liver inflammation and injury which can lead to reduced liver function or failure. HCV can be transmitted through exposure to infected blood. Many people who are infected do not show any signs or symptoms, but are still able to transmit the infection. There are 6 HCV genotypes (genotype 1-6); genotype 1 is the most prevalent in the United States.         

What are the Treatments for Hepatitis C Virus Infection? 

The old regimen for HCV treatment was the combination of ribavirin (RBV) and peglyated interferon (PegIFN). The FDA has approved 4 new drugs in the last few years that are combined ribavirin and peglyated interferon. These 4 new drugs are Solvadi (sofosbuvir), Olysio (simeprevir), Victrelis (boceprevir), and Incivek (telaprevir). A liver transplant is also a possibility if these drug treatments are not effective or if there is liver failure. The new drugs are very effective and are relatively expensive. When evaluating treatment options cost should not be the only factor considered. Efficacy, side effects, and duration of treatment should also be considered. Here is an overview of the cost of hepatitis C medications and their rates of sustained virologic response (SVR). SVR means an undetectable viral load for at least 24 weeks after treatment.
 

Also Read: New Drugs for Treatment of Hepatitis C: Victrelis, Incivek, Olysio, Sovaldi
 

Cost, Efficacy, and Side Effects of Hepatitis C Drug Regimens?

Ribavirin (RBV) + Peglyated Interferon (PegIFN) 

This combination requires the patient to be treated for a total of 48 weeks. The total cost for this drug regimen is about $41,759. In clinical trials, ribavirin + peglyated interferon produced sustained virologic response (SVR) in 34.4% to 55.2% of patients. Some side effects associated with this  treatment include  fatigue, pyrexia (fever), myalgia (muscle pain), headache, and insomnia. 

Solvadi + Ribavirin + Peglyated interferon

Solvadi + ribavirin + peglyated interferon is given for a total of 12 weeks. The cost for this drug regimen is $94,440. In clinical trials, Solvadi + ribavirin + peglyated interferon produced SVR in 78% to 91.5% of patients. Some side effects associated with this treatment include fatigue, headache, nausea, insomnia, and anemia (low red blood cells). 

Olysio + Ribavirin + Peglyated Interferon

Olysio is administered for 12 weeks and ribavirin + peglyated interferon for 24 weeks. The total cost for this drug regimen is $87,239. Patients can be placed on ribavirin + peglyated interferon for an additional 24 weeks which will increase the total cost to $108,119. In clinical trials, Olysio + ribavirin + peglyated interferon produced SVR in 60.4% to 83.9% of patients. Some side effects associated with this treatment include rash, photosensitivity (sensitive to light), pruritus (itch), and nausea. 

Victrelis + Ribavirin + Peglyated Interferon

This combination includes Victrelis given for 24 weeks and ribavirin + peglyated interferon for 28 weeks. The total cost for this drug regimen is $60,869. Patients can be treated for a longer duration depending on their response, which will increase the total cost of treatment. In clinical trials, Victrelis + ribavirin + peglyated interferon produced SVR in 52.4% to 66.8% of patients. Some side effects associated with this treatment include fatigue, anemia (low red blood cells), nausea, headache, and dysgeusia (abnormal taste). 
 

Cost and SVR Rates for Hepatitis C Treatments (Source, Janssen Therapeutics)

Incivek + Ribavirin + Peglyated interferon

This regimen includes Incivek for 12 weeks and ribavirin + peglyated interferon for 24 weeks. The total cost for this drug regimen is $87,034.  Patients can be placed on ribavirin + peglyated interferon for an additional 24 weeks which will increase the total cost to $107,914. In clinical trials, Incivek + ribavirin + peglyated interferon produced SVR in 61.9% to 77.9% of patients. Some side effects associated with this treatment include rash, pruritus (itch), anemia, nausea, hemorrhoids, diarrhea, anorectal discomfort, dysgeusia (abnormal taste), fatigue, vomiting, and anal pruritus.

Liver Transplant 

According to the United Network for Organ Sharing (UNOS) the estimated US average cost for a liver transplant is $577,100. This estimated cost includes 30 days pre-transplant care, organ procurement, hospital admission, physician services during transplant, 180 days post transplant admission care, and cost of immunosuppressants. This does not include the long-term cost of medications needed post liver transplant. Recurrent hepatitis C virus infection can occur after a liver transplantation.  

How to Reduce Hepatitis C Medication Cost? 

There are a few ways a patient can find help for paying or reducing the cost of hepatitis C medications. Pharmaceutical companies offer patient prescription savings program and prescription assistance programs that can dramatically cut cost. In addition, it is important for a patient to explore the different types of insurance plans in order to optimize drug coverage. Patient's should verify that the drug is covered by the insurance plan before selecting an insurance plan. Here are some helpful links to the prescription savings program for each company:

Solvadi Copay Coupon

Olysio Prescription Assistance

Incivek Assistance Program

Victrelis Savings Coupon

Conclusion

It is important to consider all factors, including alternative options, when evaluating the cost and risk versus benefit of hepatitis C medications. These new drugs may seem expensive relative to older regimens. However, when their superior efficacy and the real potential of achieving a cure for hepatitis C and avoiding liver transplantation or death is considered may be they are not so expensive. A liver transplant cost almost five times more than drug treatment and it is not a cure. These new drugs cost more than older regimens — the lives they save are priceless. 

References

American Association  for the Study of Liver Disease (AASLD) and Infectious Disease Society of America (IDSA) guidelines for the treatment of hepatitis C.

Transplant Living | Financing A Transplant | Costs. UNOS, 28 Dec. 2011. Web. 01 June 2014.  

Copegus (Ribavarin) Prescribing Information

PEG-Intron (Peginterferon alfa-2b) Prescribing Information

Solvadi (sofosbuvir) Prescribing Information

Olysio (simeprevir) Prescribing Information

Victrelis (boceprevir) Prescribing Information

Incivek (telaprevir) Prescribing Information