NYT Editors Mull -- With Worry -- The Astronomical US Cost Of Hep C "Cures"

While the editors primarily take aim at Gilead's sofosbuvir, branded as Solvadi^®, the same set of arguments may be made about Merck (legacy Schering-Plough) Hep C treatment boceprevir (Victrelis^®), and Vertex's telaprevir (Incivek^®). Each of those now sits a tier below the Gilead offering, which is "best in class," however, now.

Even so -- Merck's "last gen" boceprevir is not inexpensive -- and while the prices in the US for it have been declining (due largely to the arrival of the Gilead offering), it still can cost more than $40,000 for a full regimen. It, like telaprevir may well be life saving.

However, since Solvadi is all oral (and boasts clear efficacy improvements, with greatly reduced side effects), it should present an enormous prescribing advantage. Even so, the Boston-based Institute for Clinical and Economic Review suggested that the Gilead drug ought to be avoided by public payers (because its high price consumes too much of a severely-limited budget resource), and the "last gen" cheaper regimens employed. [That line of reasoning, if widely accepted, would spell trouble for Merck's next gen MK-5172 treatment for Hep C.] By the Boston non-profit's estimate, Sofosbuvir will add $18 billion to overall drug expenses, paid by public payers, in a single year. That money, they argue, could go to treating many other conditions, if Hep C sufferers could get by on the "last gen" (i.e., twice as cheap) Hep C cures. Here's a bit -- but do go read it all, at the Gray Lady:

. . . .The pill, known as Sovaldi, or generically as sofosbuvir, costs $84,000 for a standard 12-week course of treatment. That breaks down to $1,000 for each pill, taken daily. The manufacturer, California-based Gilead Sciences, says private insurers are already covering Sovaldi. The question is whether insurers and public programs like Medicare and Medicaid should have to pay so much for this drug, driving up costs for taxpayers and private policyholders.

Gilead says the price is consistent with the cost of previous treatment regimens (a contention disputed by independent experts) and is reasonable given that the drug can have fewer side effects and cures a higher percentage of patients compared with other drugs. In the long run, the company claims, Sovaldi could save money for insurers by preventing patients from getting sicker and needing costly medical care. . . .

What can or should be done to reduce the cost in the United States? Some experts suggest providing the drug only to patients with advanced liver disease. Others hope that other new drugs in late stages of clinical testing will be approved, adding competition that could help restrain prices. Still others urge that state Medicaid agencies, which cover a big portion of the infected people, negotiate with Gilead for lower prices or find ways to limit the drug’s use when other good options are available. . . .

We are all certain to hear more of this. And if the solution to the cost vs. benefit equasion were obvious, we would have it already. And we do not. It is marked by a complex, nuanced and almost intractable set of competing interests.