Why you should care about Hepatitis C

There’s a high burden of illness in developing countries such as Africa due to “medical misadventure” such as using unsterilized needles, explained Dr. Jordan Feld, hepatologist, assistant professor, Toronto Western Hospital Liver Clinic, at a recent AbbVie Canada event on drug plan sustainability.

But it might surprise you to know it’s a major health problem in Canada as well. “This actually has a huge toll in terms of healthcare morbidity, mortality and expenditure in the country,” said Feld.

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There’s a certain stigma around hep C, since the majority of people infected in Canada got it through injection drug use, he noted. However, given the disease’s slow progression, “it could have been just that one time at Woodstock,” he added. Or the patient could have contracted it from a tattoo or a blood transfusion before 1992, for example.

Hep C often leads to cirrhosis and liver cancer: the risk of cirrhosis is 41% at 30 years, and the lifetime risk is 50% to 60% higher, explained Feld. But the big challenge with liver disease is, it has no symptoms in its early stages. “People don’t really have a sense that they have a problem.”

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Here’s the good news: hep C is the first—and, currently, the only—curable viral infection, and the prevalence of cases in Canada has likely already peaked. However, there are still rising rates of cirrhosis, liver failure and liver cancer, and “it’s these patients that are really costing us a huge amount,” Feld added.

The cost of a cure
While previous treatments often had nasty side effects, there are now well-tolerated oral treatments that people can take for eight or 12 weeks to cure the infection, said Feld.

The challenge is, the new drugs come with a high price tag. Sovaldi, for example, costs $1,000 per pill.

However, “the cost of therapy is not simply the cost of drugs,” said Feld, noting it’s also important to consider the impact on sick time and overall medical expenditures. “Remember: this is curative therapy.”

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He used HIV/AIDS as an example. In Canada, HIV/AIDS drugs cost $1.2 billion per year, and they don’t actually cure the disease. If you took the same amount of money and invested it in treating hep C over 10 years, you would actually eliminate the disease from Canada, said Feld.

“The challenge for you [as a plan sponsor] is that the cost is front-loaded,” he acknowledged, while the costs of HIV/AIDS drugs are amortized over a longer period of time.

Current guidelines suggest monitoring for those in the early stages of the disease and only moving to treatment in the later stages, which might mean lower costs for private payers. But “being told you’re not sick enough for therapy is hard for patients to accept,” said Feld.

He argued treating hep C earlier prevents loss to follow up (i.e., patients who don’t come back for regular testing to determine their disease’s progression), eliminates monitoring costs and improves quality of life—and, depending on the patient’s lifestyle choices, can also help prevent future transmission. “We have to treat this disease in a pre-symptomatic stage or we miss the boat.”