A new, highly effective drug for treating hepatitis C—hailed as a cure for the disease—costs up to $84,000 per person, and is raising questions about the affordability of life-saving medications.
In the past, the only way to cure hepatitis C has been with a liver transplant, so the new drugs, including Gilead Science's Sovaldi, are good news for patients.
Other expensive drugs have come along, but not everyone can afford such treatments. Many factors affect cost, such as how much the drug will improve someone's life and how many people will need it. Other factors include what it costs a drug company to research a medication.
In the case of Sovaldi by Gilead Sciences, it has been determined that hepatitis C patients tend to have good access to private insurance or are about to become eligible for Medicare. As a result, the new drug will have a staggering cost to the U.S. of $200 billion or more over the next five years, according to a report published by Reuters.
Treatments in the Face of a Crisis
While some experts compare the cost of treating hepatitis C to HIV, the two have some notable differences. Hepatitis C has been around for a long time, but the Baby Boomer generation is increasing the number of people who are affected by the disease. HIV, on the other hand, only came to be deemed a threat in the 1980s and the cost of treating it rapidly progressed
Steven Pearson, president of the Institute for Clinical and Economic Review, told Healthline that he will convene a meeting of insurers, doctors, policymakers and scholars later this month at the California Technology Assessment Forum in San Francisco. He plans to oversee a discussion about who will bear the burden of the hepatitis C drug.
“It's going to translate into increasing health care premiums to a level that people will not find realistic, even if it's spread across everyone, which is usually what you want to do with insurance,” he said.
As many as 3.2 million Americans are suspected to have hepatitis C, according to the U.S. Centers for Disease Control and Prevention (CDC). But it can take two decades or more for symptoms to appear. Often, by that time, a liver transplant has already become necessary.
“The unusual thing about hepatitis C is that the amount being charged for the treatment is not necessarily out of line with what has been seen for other conditions such as MS or forms of cancer,” Pearson said. “When you multiply it by the cost infected, you get a budget impact of what is not tenable in the short term.”
Ranking the severity of drug costs based on the number of people who can benefit from them, their overall price and their life-saving (or life improving) potential, the new hepatitis C medication comes out on top. But there are other conditions where pricey pills have become status quo, too.
The hepatitis C debate may lead to a national conversation about when a treatment is more than our public health system can swallow.
Pearson said the public cost issues surrounding the hepatitis C drug haven't been seen since new drugs began to roll out for HIV/AIDS. “How are we going to deal with this? What if they come up with a $300,000 treatment for lupus?”
HIV affects more than 1.1 million Americans. Most of them are on expensive, life-saving antiretroviral therapy. Without it, they would develop AIDS and ultimately die. With it, they can expect to live lives almost reaching parity with the rest of Americans.
Most people in the U.S. have access to these medications regardless of their ability to pay. But the cost of the medications is spiking as single-tablet regimens become available. A medication known as Truvada, already prescribed to people with HIV, is now being used to prevent HIV.
Truvada costs $1,200 per month, or $14,400 per year. Multiplied over the course over the lifetime, the cost can be staggering.
For people who already have HIV, the cost of life-saving meds averages out at about $380,000 over the course of their lifetime, according to the CDC.
F. Randy Vogenberg, principal at the Institute for Integrated Healthcare in Greenville, S.C., told Healthline that cancer is not necessarily a death sentence anymore. A pharmacist who also has a Ph.D in healthcare management, Vogenberg said innovation and improved clinical outcomes are clashing with the almighty dollar.
“These two are juxtaposed against one another. All this great technology leads to saving lives, but at what cost does that happen and how can we afford that? That's what's playing out right now in the marketplace," he said. “As a society we haven't really come face to face with this issue head on. What do you mean by health insurance? What do you mean by coverage? It's not a free lunch. Is health care a right? Is that what they're saying?”
Biologics to treat cancer can run as high as $32,000, not including transfusion costs, according to San Francisco Bay area internist Dr. David Belk. Surgery and other forms of treatment still may be required.
Patients with leukemia or lymphoma, cancers of the blood, face similar high costs.
Drugs for multiple sclerosis and other inflammatory diseases are also at the top in terms of medication costs. Many of these drugs, although they improve and extend lives, don't save them.
Drugs to treat multiple sclerosis can run upward of $5,000 per month, according to Walgreens and Walmart pharmacies in Northeast Florida.
A number of biological drugs have emerged to treat various forms of arthritis. But again, they don't save lives and can only improve them to varying degrees.
Biologicals to treat various forms of arthritis run upward of $12,000 per year, according to the American College of Rheumatology.