Amid all the outcry over the high cost of new hepatitis C therapies, including congressional hearings, a simple fact has been overlooked: The VA expects to save money in the long run because of the drugs’ high cure rates.
By Annette M. Boyle
WASHINGTON — Despite congressional hearings held to decry the high costs of drugs that essentially cure hepatitis C, at the VA, those therapies are likely to translate into significant savings, both for immediate treatment costs and long-term care.
To start with, the cost of the latest treatments is not significantly higher than the previously recommended therapy. The VA generally enjoys a 24% discount off the standard price for HCV drugs. The new drugs have a steeper discount.
Even accounting for fluctuations in treatment costs between October 2014 and January 2015, “the cost of a 12-week Harvoni course is cost neutral compared to a 12-week course of the previous triple therapy Sofosbuvir-peginterferon-ribavirin based regimen,” said David Ross, MD, director of the VHA’s HIV/HCV and public health pathogens program.
“Using current VA costs, the cost of 12 weeks of Viekira Pak is 53% less than the cost of a 12-week course of the previous triple therapy Sofosbuvir-peginterferon-ribavirin based regimen,” he added, cautioning that not all veterans with HCV will qualify for the less-expensive treatment because of their stage of disease or interactions with other drugs they take.
Still, treating every eligible patient with HCV comes with a big price tag, especially since, as of 2014, only about 17% of current VA patients with the infection have ever received any kind of antiviral treatment. In some cases, administration of the toxic drugs was delayed in anticipation of availability of the new treatments with higher cure rates and lower side effects.
Now, with the new drugs, 50% of HCV-infected veterans are expected to be treated and cured by 2023, according to a budget developed by the Obama administration, although many at the VA have suggested that will occur more quickly.
The VA estimates that 233,000 veterans have HCV, with about 180,000 of them having received a diagnosis. As of June 2014, approximately 108,810 patients were treatment candidates, meaning they had been diagnosed, had their genotype of HCV determined and had not been cured.
“Because of the large number of veterans infected with HCV, the costs of treating this many veterans will be substantial, regardless of the regimen used,” Ross told U.S. Medicine.
For FY 2015, the VA has allocated $696 million for the purchase of HCV drugs, roughly 16% of a total outpatient pharmacy budget of $4.3 billion. As of Feb. 28, the VA had spent more than $300 million on HCV drugs this fiscal year, as much as it spent on HCV treatment for all of FY 2014, Ross said.
There’s little question all of the funds allocated will be used. As of the end of February, more than 14,000 patients had initiated treatment on one of the four new treatment regimens (Sovaldi, Sovaldi plus Olysio, Harvoni or Viekira) and 8,000 of them had received an interferon-free therapy. The VA is starting 733 new patients on HCV therapy each week.
Ross noted that “it is the policy of the U.S. Department of Veterans Affairs to offer anti-viral treatment for chronic hepatitis C virus infection based solely on clinical benefit, without consideration of cost. VA does not restrict anti-viral treatment based on stage of liver disease.”