CHI Report – Innovation in Hepatitis C Treatment – Page – 7
The Opportunity to Act
Scientific advances over the years have had a profound impact on the US hep C epidemic, in terms of both health outcomes (reduced morbidity and mortality) and economics (for example, fewer physician visits, reduced hospital care, increased productivity), and will continue to do so. The economic debate over the prices of new treatments has dominated the public sphere. To balance that debate with an accurate understanding of the human impact of treatment innovation, we asked the question: How much better off today and tomorrow are people in the US as a result of the breakthroughs in treating hep C?
To answer this question, we collaborated with the Center for Disease Analysis (CDA), an independent research organization based in Colorado that conducts epidemiological analyses to assist governments and organizations with policy decisions. CDA constructed an epidemiological model to simulate the US hep C epidemic, in which people enter the system with new infections, progress through the various stages of the disease, and exit the system either when they are cured through drug treatment or when they die. To assess the impact of treatment innovation on the hep C epidemic in the US, we started with today’s HCV-infected population and modeled different treatment regimens from 2013 through 2030. To simplify the analysis, we held the diagnosis and treatment rates constant and altered only the SVR and compliance rates based on different, hypothetical treatment regimens. A detailed overview of our methodology and assumptions can be found in the appendix.
The results are a powerful demonstration of the impact that treatment innovation can have on human life. As seen in Exhibit 5, if no hep C drugs were available today (the “no drug treatment” scenario), hep C mortality would rise steadily, cumulatively claiming nearly half a million US lives from 2013 through 2030. Assuming a switch to the new “interferon-free regimens,” the model shows deaths from hep C beginning a sharp decline around 2025, such that 67,000 US lives that would have been lost with no treatment would be saved over the 2013-2030 period. Importantly, even a switch from today’s standard of care (“protease inhibitors”) to the new “interferon-free regimens” yields a substantial difference of more than 30,000 lives saved by 2030. While the exact figures are, of course, dependent on numerous assumptions (described in detail in the appendix), the shape of the mortality curves over time clearly illustrates the difference improved medicines can make in saving lives.
As a proxy for morbidity, we modeled the number of new liver-cancer cases (Exhibit 5). In the “no drug treatment” scenario, 230,000 people in the US would have newly developed liver cancer by 2030. A switch from “no drug treatment” to “interferon-free regimens” could prevent 40,000 of those cases. A switch from “protease inhibitors” to “interferon-free regimens” could prevent 16,000 new liver-cancer cases.
At the same time that these new high-impact drugs are entering the market, changes in the US health-care system increase the likelihood that more infected people will be diagnosed and treated for hep C. The recently issued CDC recommendation to screen all baby boomers for hep C, as well as the expansion in health care coverage under the ACA, should increase diagnosis and treatment rates. Exhibit 6 illustrates the potential impact that treatment and diagnosis scale-up will have on the suffering caused by hep C. Even a 5 percent annual increase in the number of patients treated with the new interferon-free agents could save 27,000 additional lives by 2030, on top of the 30,000 lives saved by switching to the new drugs, as described above.
Of course, scale-ups in treatment require significant financial investments, and detailed cost-benefit analyses will be necessary to determine how expanding treatment should be optimally timed and deployed. Ensuring that not only more patients but also the right patients have access to appropriate medications will be crucial to realizing the potential of the new treatments. This is a complex challenge that will require the collaboration and coordination of pharmaceutical companies, governments, payers, physicians, and patients.
10 Based on clinical trials; not yet approved by the FDA
11 Because the real-world compliance rates for interferon-free agents are not yet known, we used clinical-trial compliance rates for all regimens in our analysis (detailed in the appendix). These compliance rates are likely to be overestimates