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Hepatitis C cure may be costly — but also cost effective

Hepatitis C patients could now receive a life-saving cure

WHEN WAS the last time you heard of a genuine cure for a lethal disease? Hepatitis C has just been transformed from a chronic, and often fatal, condition to a disorder that can be completely cured.

Only a few years ago, many patients with hepatitis C infection died of the disease, with no uniformly effective therapy in sight. However, over the last decade, leading scientists and clinicians working in academia and at companies such as Abbvie, Gilead, Johnson & Johnson, and Vertex have converted a death sentence into a curable disease. The treatments approved at the end of last year by the Food and Drug Administration for hepatitis C represent the vanguard of a slew of future biotech cures for currently lethal cancers and other diseases.

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There are currently roughly 150 million people infected worldwide with hepatitis C. One quarter of these patients develop liver failure, and many also develop liver cancer as a result of their infection. Nearly 500,000 people die every year due to hepatitis C infection.

The future will be very different: Many hepatitis C patients now have the hope of receiving a therapy that can completely cure them of their infection. The drugs just approved by the FDA eradicate the hepatitis C virus from their bodies. This is a cure for not just a few lucky patients, but instead for well over 90 percent of patients.

But it remains to be seen how quickly society will be able to bring these new cures to all patients who can benefit. At well over $80,000 per patient, the new therapies for hepatitis C are expensive — so much so that some insurance companies and state Medicaid officers are bridling at the thought of billions of dollars in extra costs. But given the societal benefit of completely curing patients with expensive and lethal disease, the cost-benefit analysis on these drugs appears straightforward — insurance and society should pay for these life-saving drugs, since significant chronic disease will be avoided.

The same cost-benefit analysis doesn’t necessarily apply to nations that spend signficantly less on health care. There’s no question that certain populations in developed and developing countries will have a harder time getting full access to these life-saving medicines. Still, even here there is hope for a good outcome. Life-saving HIV drugs, discovered almost two decades ago, are now much more widely available, at a lower price both in the United States and in developing countries. Similar models allowing full access for all patients infected with hepatitis C are sorely needed.

Indeed, the FDA’s approval of a new generation of drugs to fight hepatitis C may be one of the least-heralded breakthroughs in medical history. It presages a new era of biotech cures, and establishes a model for both the quick development of life-saving treatments and, hopefully, their equally speedy availability to patients.

The life-saving new hepatitis therapies demonstrate the vast potential of exquisitely specific “magic bullets” for infectious diseases and cancer.

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The hepatitis C cures were developed so quickly because the HIV epidemic taught scientists and clinicians to employ combination therapies to treat viral infections (combination therapies are also a great new hope in cancer therapy). Additionally, the FDA turbocharged drug development timelines by allowing new medicines for hepatitis C to be quickly studied in human proof of concept studies, not against the previously poor standard of care — a process that would have taken many additional years. Instead, the faster studies could quickly document the astonishing, and astonishingly rapid, cures engendered by these novel medicines.

In addition, the effective new hepatitis therapies demonstrate the vast potential of exquisitely specific “magic bullets” for infectious diseases and cancer. As medicine has become smarter about disease, very targeted drugs with highly tailored activities are showing profound effects in specific and defined patient populations. With increasing frequency, biotechnology is likely to “pick off” specific diseases, which were previously fatal, and convert them into chronic conditions (like HIV) or cure them (like hepatitis C, or certain types of cancer).

It’s tempting to view these coming biotech cures as contributors to the skyrocketing cost of health care. But the reality could be just the opposite. Just as government, scientists, and doctors collaborated in bringing hepatitis C cures rapidly to market, they will surely work closely together to make sure that all patients can benefit from novel, transformative medicines for hepatitis, cancer, and many other diseases.

Dr. Christoph Westphal is a graduate of Harvard Medical School, where he now serves on the board of fellows. He is a biotech entrepreneur and investor via the Longwood Fund, and has no financial or scientific ties to hepatitis therapies or the companies mentioned here.
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