What is the current cost of Telaprevir, Ribavirin, and Interferon ? I'm wondering what the total cost would be, as well as each drug. I will be starting treatment in about 6 weeks, or less, hopefully. Thanks
What is the current cost of Telaprevir, Ribavirin, and Interferon ? I'm wondering what the total cost would be, as well as each drug. I will be starting treatment in about 6 weeks, or less,with no Insurance . Thanks
Depending on where you live in the world. There is different financial assistance for Hepatitis C depending on your location. The treatment medications are vert costly. In the tens of thousands not scare you. Go to "Incevik.com" and see financial assistance that's offered. You can find assistance for Hepatitis C treatment. Where there's a will...there's a way.
WASHINGTON, DC — The expense of telaprevir-based triple therapy for hepatitis C — including adverse event management — is $189,000 per sustained viral response, report investigators.
"Our findings indicate that the benefit-cost ratio is lower than projected, based on results of the registration trials," lead investigator Andrea Branch, MD, from the Icahn School of Medicine at Mount Sinai in New York City.
Kian Bichoupan, MBS, who is Dr. Branch's first-year PhD clinical research student, presented the results here at The Liver Meeting 2013.
The number seemed to alarm session comoderator Sammy Saab, MD, from the David Geffen School of Medicine at UCLA, who called it "very surprising." It is "at least double what we think the cost is. I didn't know the cost of actually curing someone was so high," he said.
It is expected that 2 new direct-acting antiviral agents for the treatment of hepatitis C, simeprevir and sofosbuvir, will be approved by the US Food and Drug Administration (FDA) on December 8. Both have far better adverse-event profiles than telaprevir-based regimens, but the degree to which the cost-effectiveness calculation will change depends on their price, which hasn't yet been announced, Dr. Saab explained.
The benefit-cost ratio is lower than projected.
Before telaprevir received FDA approval in May 2011, the standard of care for genotype 1 hepatitis C was 48 weeks of pegylated interferon and ribavirin. With that regimen, the sustained viral response ranged from 40% to 50%. With the addition of telaprevir to the peginterferon and ribavirin regimen, response rates increased to 64% to 75%, but adverse events and costs also rose.
Previous studies have shown that peginterferon and ribavirin dual therapy costs $70,364 per sustained viral response in patients with genotype 1 hepatitis C. Data from phase 3 registration trials suggest that telaprevir-based triple therapy is cost-effective, but real-world data have been unavailable until now, Bichoupan said.
The researchers evaluated 147 patients who initiated telaprevir-based triple therapy at Mount Sinai. The mean age of the cohort was 56 years, and 68% of the cohort was male, 19% was black, 46% did not respond to previous hepatitis C treatment, and 35% had advanced fibrosis or cirrhosis.
They calculated the cost of the therapy itself and the management of adverse events from Medicare, the Agency for Healthcare Research and Quality, and other sources.
Sustained viral response was achieved by 44% of patients. At 48 weeks, the cost of telaprevir was $55,273, of peginterferon was $30,418, and of ribavirin for $4926. Telaprevir accounted for 61% of the $90,617 total, Bichoupan noted.
Adverse events, primarily anemia, accounted for 8% of the total cost; 48% of the patients required treatment with epoetin alpha, 9% needed blood transfusions, 8% were treated with granulocyte colony-stimulating factor (G-CSF), 13% required hospitalization, and 10% made emergency department visits.
Total costs were $664,083 for epoetin alfa, $29,007 for G-CSF, and $12,644 for transfusions.
The total cost of treating hepatitis C was higher for the 65 patients who achieved sustained viral response than for the 82 who did not ($6.33 vs $5.24 million).
The median cost per patient was $83,509. The researchers multiplied that by the reciprocal of the 44% sustained viral response (2.27), and arrived at $188,859 per response.
The cost per sustained viral response was lower for treatment-naïve than for previously treated patients ($158,403 vs $199,134). For patients with advanced liver fibrosis, the cost was $185,484. For those with less severe fibrosis, the cost jumped to $256,977, Bichoupan reported.
He pointed out that this study started when telaprevir had just reached the market, and that outcomes might improve over time with better strategies for preventing adverse events.
Dr. Branch told Medscape Medical News that these data can't determine whether nearly $200,000 per sustained viral response is cost-effective, because not enough is known about the cost savings associated with such a response.
Other investigators have compared health costs for patients who achieve a sustained viral response with costs for patients with chronic hepatitis C infection. However, "this is not the best way to do the analysis because patients who achieve a sustained viral response may be healthier than patients who do not," Dr. Branch noted.
Dr. Saab said he agrees that the cost figures are likely to improve as experience with the drugs increases. However, he noted that telaprevir will likely disappear soon after the expected FDA approval of simeprevir and sofosbuvir.
Dr. Branch echoed this opinion. Telaprevir-based regimens "are only appropriate for patients who cannot wait even a few months for newer regimens to complete the FDA review and approval process," she said.
This study was supported in part by Gilead Sciences, the National Institute of Drug Abuse, and the National Institute of Diabetes and Digestive and Kidney Diseases. Dr. Saab is a consultant to Bristol-Myers Squibb.
The Liver Meeting 2013: American Association for the Study of Liver Diseases (AASLD). Abstract 244. Presented on November 5, 2013.
Primary Care Option for Hepatitis C Treatment Cost-Effective
Miriam E. Tucker
November 14, 2013
WASHINGTON, DC — The Extension for Community Healthcare Outcomes (ECHO) program, which trains primary care physicians to treat patients infected with hepatitis C in underserved communities, is cost-effective, a new analysis shows.
"ECHO provides resource-efficient access to care for underserved communities," John Wong, MD, from Tufts University in Boston, told Medscape Medical News.
He presented the findings here at The Liver Meeting 2013.
The ECHO program, developed at the University of New Mexico Health Sciences Center, uses teleconferencing to help primary care physicians and specialists at the university comanage patients with chronic hepatitis C infection in 16 underserved rural areas and 5 correctional facilities.
Initial efficacy findings for 407 patients showed that the rates of sustained viral response at ECHO sites were nearly identical to those at university clinics (58.2% vs 57.5%) (N Engl J Med. 2011;364:2199-2207).
The cost is $3000; that's nothing, and the cure rate is as good as at a university.
Dr. Wong and his team compared the cost of pegylated interferon plus ribavirin with no treatment for each of 261 patients at the 21 ECHO sites. Mean patient age was 42 years, 73% were male, and 95% were white. A quarter had cirrhosis, 30% had moderate hepatitis, and 56% had genotype 1 hepatitis C.
Factored into the model were costs for office visits, lab tests, antiviral drugs, adverse effects, psychiatry, travel, productivity, and corrections personnel.
Compared with no treatment, the researchers projected that ECHO management would reduce the lifetime incidence of cirrhosis by 63%, decompensated cirrhosis by 46%, hepatocellular carcinoma by 45%, and liver death by 46%.
With ECHO, projected life expectancy would increase by 4.4 years, producing a cost saving of $12,200 without discounting for future disease costs. With discounting, ECHO had a cost of $9,000.
Compared with no antiviral therapy, the program saves money in 35% of patients overall, in 30% of patients in the community setting, and in 43% of patients in correctional facilities. Another 23% benefited with ECHO management, but some at higher costs. In 42% of patients, the treatment didn't work.
The incremental cost-effectiveness ratio — the rate of additional cost to additional benefit — was $3700 for the entire study population, $5800 for the community, and $1400 for the corrections facilities.
The incremental cost-effectiveness ratio reflects what the intervention costs to increase life expectancy by 1 year of perfect health (cost-quality-adjusted life-year gained). The World Health Organization considers an intervention to be very cost-effective if that ratio is less than the per capita gross domestic product of a country, and to be cost-effective if it is less than 3 times the per capita GDP, Dr. Wong explained.
"The mean per capita GDP in the United States is $50,000, so this is 10-fold lower, and therefore very cost-effective," he said.
Dr. Wong reported that ECHO now includes triple therapy and that he expects the much-anticipated polymerase inhibitor sofosbuvir and the protease inhibitor simeprevir to be added once they are approved by the US Food and Drug Administration. He said he anticipates that ECHO will be cost-effective as long as triple therapy remains effective.
Both session comoderators told Medscape Medical News that they are impressed with the findings.
"I think it shows that increasing access isn't costly, it's cost effective. The cost is $3000; that's nothing, and the cure rate is as good as at a university," said comoderator Sammy Saab, MD, from the David Geffen School of Medicine at UCLA.
"If the new hepatitis C drugs have a better safety profile, a lot of the treatment can be undertaken by primary care providers, which would be a huge boon for people," added comoderator Kiran Bambha, MD, from the University of Colorado Medical Center in Denver.
Dr. Wong and Dr. Bambha have disclosed no relevant financial relationships. Dr. Saab is a consultant to Bristol-Myers Squibb.
The Liver Meeting 2013: American Association for the Study of Liver Diseases (AASLD). Abstract 245. Presented November 5, 2013.
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