Cheaper, shorter duration, better patient outcomes


For the more than 70 million people worldwide living with hepatitis C virus (HCV) , the past five years has seen this infectious, potentially fatal infection transform into a curable disease. The main risk factors for HCV are unprotected sexual intercourse and intravenous drug use. As such, there is a high correlation between HCV, sexually transmitted diseases (STDs) and HIV infections.

Guidelines for the current management of hepatitis C infection continues to rapidly evolve. Most recent recommendations may be found at:

https://www.hcvguidelines.org

With the introduction of all-oral, peg-interferon-free, direct-acting antiviral (DAA) treatment options, patients with HCV may be treated very effectively (with about 97% success on average), with few side effects. Moreover, unlike older generation, peg-interferon-containing treatments, DAA treatment durations are short; they typically last for 12 weeks.

However, these medications are expensive and as such, guidelines reserve treatment for people with more advanced disease (e.g., cirrhosis). Recently, there appears to be a shift in opinion regarding the burden of HCV and the role of early treatment in reducing it. It has been shown that treating HCV at an early stage of the disease may in fact lower overall healthcare costs. In an article that appeared in Medscape:

A health state-transition model of the natural history of hepatitis C shows that early therapy with the combination of glecaprevir and pibrentasvir (Mavyret, AbbVie) results in lower lifetime costs because of reductions in the risk for decompensated cirrhosis, hepatocellular carcinoma, liver transplantation, and liver-related mortality. 

"What's new here is that if you're assuming treatment, the costs are lower to treat earlier, because you move from a 12-week to an 8-week regimen, on average," said researcher Scott Johnson, PhD, from Medicus Economics in Boston.


https://www.medscape.com/viewarticle/895236

If this trend continues, we could very well see the near eradication of hepatitis C in the next decade. With the high efficacy and tolerability of DAA regimens, and the high burden of advanced disease, people who are at risk of HCV should get tested, while those with HCV infection should seek treatment early.