In 20 years, we can make hepatitis C rare – if we can afford the cure


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For all that's been written about the high cost of a new breakthrough cure for hepatitis C, there's one part that can get overlooked. The wave of new treatments and screening options could help wipe out the disease that kills about 15,000 Americans a year.

New research this week finds that hepatitis C, which has infected as many as 3.2 million Americans, can become a "rare disease" within about 20 years thanks to advances in treatment and new screening guidelines. By 2036, the liver disease could be considered a rare disease, meaning it infects no more than 1 in 1,500 people, according to National Institutes of Health-funded research in the Annals of Internal Medicine.

Up to 75 percent of people who have hepatitis C aren't aware they have it, according to the Centers for Disease Control and Prevention. But baby boomers, who account for about three-quarters of infected Americans, could greatly benefit from Medicare's recent decision to cover hepatitis C screening tests. The screening will help identify 487,000 hepatitis C cases over the next decade, according to the computer model researchers developed.

But the researchers find even more aggressive screening guidelines could make hepatitis C a rare disease by 2026 — 10 years earlier than their baseline projection. One-time universal screening would identify 933,700 cases in the next decade, and the benefits would be tremendous. The screenings, according to researchers' projections, would prevent 161,500 liver-related deaths, 13,900 liver transplants and 96,300 cases of the most common type of liver cancer.

But more aggressive screening would also mean greater pressure to pay for the new drugs. One of the biggest debates in health care in recent months has been over the $84,000 cost of Gilead Sciences' Sovaldi, the new hepatitis C drug that's for more effective and safer than past treatment options.

State officials are worried about the drug blowing up Medicaid budgets, as some are taking steps to limit its use to just the sickest patients in hopes of negotiating a better price or waiting to see if competing drugs expected to hit the market will be cheaper. As The New York Times pointed out this week, Sovaldi puts a major strain on prison budgets, too. Another study this week found that Sovaldi alone could increase spending in Medicare's drug program between $100 and $200 per beneficiary in 2015 (though Medicare said it expects average premiums to increase by just $1 next year).

Gilead and the lobbying group representing drugmakers argue that Sovaldi's price tag is justified by the long-term savings to the health-care system from avoiding costlier procedures, like liver transplants. However, that could be a tough argument for groups who pay for the drug, since they might not benefit from those long-term savings given how people change health plans or eventually become eligible for Medicare, Aaron Carroll writes for the Incidental Economist this week.

There's a real chance to reduce the prevalence of a terrible disease, the new research shows. But, as the researchers warn, the high cost of the new drugs "could become a barrier" to timely treatment.

Jason Millman covers all things health policy, with a focus on Obamacare implementation. He previously covered health policy for Politico.
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