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HICprevent

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This award-winning blog supplements the articles in Hospital Infection Control & Prevention.

The price of a needlestick just went up: New HCV drugs offer a cure at a substantial cost

March 18th, 2015

Some 3 million Americans have hepatitis C virus, and any one of them could be the next source patient in a needlestick exposure to a health care worker. If transmission occurs and the disease progresses HCV can take your liver and your live. Not that long ago the worker’s options were limited, but now there are new HCV treatments that can essentially cure the disease and reduce the virus to undetectable levels. What’s the catch? Well, at more $1,000 a pop the pill is easier to swallow than the price tag.

As reported in the Feb. 2015 issue of Hospital Employee Health, the good news of dramatically improved HCV drugs is tempered by a reminder of the staggeringly expensive cost to treat a single seroconversion following a needlestick. With no vaccine nor post-exposure prophylaxis, HCV presents a rare but real risk to health care workers. An estimated 1.8% of those exposed to HCV through a needlestick acquire the infection. But the consequences can be dire. About two-thirds of those infected with HCV develop chronic liver disease, and up to 20% will develop cirrhosis. Five percent will die.

For employers, a needlestick can lead to a lifetime of medical costs. “Their responsibility is to cover the cost of the treatment to resolve that occupational injury or illness,” says Joseph Paduda, MS, principal with Health Strategy Associates, a consulting firm based in Skaneateles, NY, that specializes in managed care for workers’ compensation.

New hepatitis C drugs have literally been life-savers. In 2013, the U.S. Food and Drug Administration approved Olysio (simeprevir) and Sovaldi (sofosbuvir) to treat chronic HCV infection, genotype 1. (The most common HCV genotype found in the United States.) Olysio was approved for use in combination with peginterferon-alfa and ribavirin. In 2014, the FDA approved an Olysio-Sovaldi combo. A randomized trial found that Olysio and Sovaldi in combination produced a sustained virologic response (non-detectable HCV, which is considered to be a cure) in 93% of participants after 12 weeks and 97% after 24 weeks. That included patients with cirrhosis.1 In October 2014, the FDA approved another combination drug called Harvoni (ledipasvir and sofosbuvir) that showed a success rate of up to 99% in treating chronic HCV, genotype 1.

While the cure rates of this new vanguard of HCV drugs are astonishing, so is the price. A 12-week regimen costs about $66,000 for Olysio and $84,000 for Sovaldi, making the combination about $150,000. People with cirrhosis may need a 24-week supply, bringing the price tag to $300,000. Twelve weeks of Harvoni costs $94,500. (In December, the Southeastern Pennsylvania Transportation Authority in Philadelphia filed suit against Sovaldi-maker Gilead, accusing it of price-gouging.)

Yet treatment for advanced cases of HCV has always been expensive – particularly if the patient treatment endpoint is a liver transplant. In that context, the new drug treatments avoid ongoing liability.

“You could potentially close the entire claim if they’re cured,” says Brenda Wood, PharmD, BPharm, director of clinical services for Healthcare Solutions, a Duluth, GA-based company that provides medical cost management for workers’ compensation.

--Michele Marill

For more on this story see the February 2015 issue of Hospital Employee Health.

Reference

1. Lawitz E, Sulkowski MS, Ghalib R, et al. Simeprevir plus sofosbuvir, with or without ribavirin, to treat chronic infection with hepatitis C virus genotype 1 in non-responders to pegylated interferon and ribavirin and treatment-naive patients: the COSMOS radomised study. Lancet 2014;384: 1756-1765