February 22, 2012

New Hepatitis C Treatment

(Ivanhoe Newswire) — Nearly four million people in the United States are infected with genotype-1 hepatitis C – a virus that attacks the liver, causing swelling, scarring, cancers and the need for transplants. And unlike hepatitis B, there is no vaccine for hepatitis C, until now.

Up until last summer, treating people with hepatitis C was a gamble, with many side effects, including anemia, vomiting, hair loss and depression.

"These treatments are very uncomfortable and long – up to 48 weeks," Jeremy Goldhaber-Fiebert, PhD, assistant professor at the Sanford University School of Medicine, was quoted as saying.

"Many people likened the experience to cancer chemotherapy: hard to undergo if the chance of treatment success is not that high."

With an impending spike in illnesses among the hepatitis-C-infected population in the United States, researchers and physicians have been developing new tests and treatments. The latest in a series of improved therapies – and the focus of the study – are two new virus-targeting drugs called protease inhibitors, boceprevir (trade name Victrelis) and telaprevir (trade name Incivek).

The drugs, which came out in the summer of 2011, were designed to be taken in conjunction with the standard treatment, which itself is a combination of two drugs, an interferon and an antiviral called ribavirin.

While the new triple therapies increase the chances of kicking the virus, they have more severe side effects – such as full body rash and rectal bleeding – and boost costs. Boceprevir adds $1,100 per week to the cost of treatment, and telaprevir adds $4,100 per week.

"At the outset, it was not at all clear to me that drugs as expensive as these, which are added onto the standard therapy, would result in sufficient benefits and reduced costs from averted liver cancers and transplants to make them cost-effective," said Goldhaber-Fiebert.

To find the answers, Goldhaber-Fiebert and his colleagues created a computer model of the hepatitis C disease. They compared the pros and the cons of three treatment strategies. And after intense statistical and simulation analysis, they found that the new triple therapies were indeed cost-effective for chronic hepatitis C patients with advanced liver disease. Despite the large price tag and side effects, the new treatments help these patients avoid costly cancers and liver transplants – as well as allowing them to live longer, higher-quality lives.

The closer the threat of severe disease, the more justified treatment costs and risks become, said Goldhaber-Fiebert. "That would be the bottom line."

"As more and better treatments become available, the decision will continue to evolve, requiring further analysis," added Shan Liu, a graduate student in management science and engineering in the School of Engineering and lead author of the study. "Patients and health systems could also benefit from price competition with multiple treatment options available."

"But ultimately, treatment decisions will remain a private conversation between a doctor and a patient," Liu was also quoted as saying.

SOURCE: Stanford University Medical Center, February, 2012