The Cost of Hepatitis C


Hepatitis C is a costly disease, not only to the wallet, but to the body as well. With recent advances in medicine, the challenge in ridding the planet of this scourge is now a matter of economics rather than technology. Yes, hepatitis C is a costly but curable disease.

What we now know as hepatitis C (HCV) was first identified in 1989, when it was known as non-A, non-B hepatitis in order to differentiate it from the other known forms of the disease.

Stored blood samples from the 1940s have provided the earliest documented presence of the virus, but scientists agree that it has been around for much longer. Today, 130−150 million people are infected with HCV, resulting in approximately 700,000 deaths per year.

The Priceless Consequences of Hepatitis C

Failure to effectively treat hepatitis has caused increased incidences of liver cirrhosis, liver cancer,
and premature mortality.

There are also non-liver manifestations of the disease, such as eye problems,2,3 insulin resistance, and "brain fog" unrelated to the treatments given.

Hepatitis C Treatment Timeline

For many years, hepatitis C therapy centered on a combination of ribavirin and injectable pegylated alpha interferon, a therapy accompanied by significant side effects. Furthermore, the combination provided long-term viral clearance to only half of its users.

The approval by the U.S. Food and Drug Administration (FDA) of direct acting antiviral (DAA) drugs in 2011 has been met with unbridled enthusiasm, with some headlines proclaiming that their approval heralded the beginning of an era and the end of HCV. Early treatment with the DAAs telaprevir and boceprevir combined with interferon and ribavirin significantly improved patients' chances against the most common U.S. HCV genotype (type 1).

In 2014, Gilead Sciences' Harvoni®, a combination of ledipasvir and sofosbuvir, exploded on the scene with its one pill per day, eight−twelve week regimen that offers a 96% or higher cure rate for HCV genotypes 1, 4, 5, and 6. (Sofosbuvir, approved for hepatitis C in 2013, is sold alone as the drug Sovaldi® that, combined with ribavirin and/or interferon treats HCV genotypes 2 and 3, which are not treatable by Harvoni®.)

But there's just one catch. Harvoni®'s "I am ready" TV ads with its smiling actors neglect to mention that the drug currently costs $1,000 per pill.

Solvadi® and Harvoni® have attained blockbuster status. In 2015, the two drugs generated a total of $19.1 billion in combined sales. While 12 weeks of Solvadi costs U.S. consumers an estimated $85,000 (at an estimated cost to Gilead of $130) the same treatment with Harvoni® can cost over $94,000. It is no wonder that some insurance companies and states' Medicaid programs will only cover the cost of the drugs for patients with advanced disease, leaving many individuals with the choices of borrowing large sums of money, selling their homes, or going without treatment and facing an increased risk of cirrhosis or liver cancer.

While the need for pharmaceutical companies to recoup the astronomical costs of research and drug approval is acknowledged, it is interesting that in other countries, the price of these new therapies are significantly lower.

As of this writing, news has arrived of the approval of yet another potential HCV blockbuster. Gilead Sciences' Epclusa®, a combination of Sofosbuvir and Velpatasvir, not only treats all six HCV genotypes with a once-daily tablet, but is priced lower than Solvadi® and Harvoni® at $74,760 for a 12-week treatment course.

This latest "miracle drug" could herald the eventual end of combination therapy with ribavirin and/or interferon for many HCV patients, freeing a large number of individuals from prolonged and severe side effects. In a clinical trial involving participants with mild or no cirrhosis, 95% to 99% had no detectable virus in blood tests administered 12 weeks after finishing treatment with Epclusa®.4 Another trial that involved HCV patients with moderate to severe cirrhosis treated with Epclusa® and ribavirin resulted in no detectable viral load in 94% of the subjects.

Nutrients That Nourish Your Liver

For those faced with the challenging situation of having to wait for their insurance to authorize payment for these wonder drugs, there are supportive nutrients for the liver that can be used with a physician's approval. Silymarin, derived from milk thistle, has antiviral, anti-inflammatory, and antifibrotic effects within the liver.5-8

The fruit of another plant, Schisandra, which has been used in Chinese medicine for centuries, was found to inhibit HCV in an in vitro study that compared Schisandra berries to two other plant compounds present in a traditional Japanese formula.9

Quercetin, a flavonoid that occurs in apples, onions, and other plant foods, has been shown to reduce production of the HCV virus in two separate in vitro studies.10,11

Interestingly, drinking coffee has been associated with a reduced likeliness of liver fibrosis or cirrhosis.12 In this meta-analysis of 16 studies, the authors demonstrated that coffee consumption is associated with a 39% lower risk of cirrhosis compared to the risk experienced by those who did not drink coffee. When advanced hepatic fibrosis was evaluated, drinking coffee was associated with a 27% lower risk than not drinking the beverage. Subgroup meta-analysis of patients with HCV also affirmed a protective effect for coffee drinking12.

In a study of patients with chronic HCV, 38% of whom had advanced liver fibrosis, subjects without fibrosis were found to have a higher intake of caffeinated coffee, and a higher intake of caffeine from all sources.13 The authors of the study concluded that as little as 100 milligrams of caffeine per day could protect against advanced hepatic fibrosis in males with chronic HCV. In vitro, caffeine has been shown to inhibit HCV replication at nontoxic concentrations.14 In another study, the coffee compound known as caffeic acid inhibited the initial stage of infection by two HCV genotypes in studies in human liver cells.15

Despite the cost issue, it is exciting to be at a point in history where there is a cure for most cases of hepatitis C. We hope to witness similar breakthroughs in cancer, Alzheimer's disease, and other chronic diseases in the near future.

References:

  1. World Health Organization. http://www.who.int/mediacentre/factsheets/fs164/en/ Accessed July 6, 2016.
  2. Misiuk-Hojło M et al. Przegl Epidemiol. 2007;61(3):545-50.
  3. Zegans ME et al. Curr Opin Ophthalmol. 2002 Dec;13(6):423-7.
  4. U.S. Food and Drug Administration. http://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm508915.htm Accessed July 6, 2016.
  5. Polyak SJ et al. Gastroenterology. 2007 May;132(5):1925-36.
  6. Bonifaz V et al. Liver Int. 2009 Mar;29(3):366-73.
  7. Morishima C et al. Gastroenterology. 2010 Feb;138(2):671-81, 681.e1-2.
  8. El-Lakkany NM et al. Parasit Vectors. 2012 Jan 11;5:9.
  9. Cyong JC et al. Am J Chin Med. 2000;28(3-4):351-60.
  10. Gonzalez O et al. Hepatology. 2009 Dec;50(6):1756-64.
  11. Bachmetov L et al. J Viral Hepat. 2012 Feb;19(2):e81-8.
  12. Liu F et al. PLoS One. 2015 Nov 10;10(11):e0142457.
  13. Khalaf N et al. Clin Gastroenterol Hepatol. 2015 Aug;13(8):1521-31.e3.
  14. Batista MN et al. Arch Virol. 2015 Feb;160(2):399-407.
  15. Tanida I et al. Jpn J Infect Dis. 2015;68(4):268-75.

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