Hard News by Russell Brown

How can the new treatments for Hep C be "cheap and easy to administer" if they cost $80 to $100k per patient? If we have 50,000 people infected, it would cost billions to treat them all at that rate.

How can the new treatments for Hep C be "cheap and easy to administer" if they cost $80 to $100k per patient

The administration is cheap and easy (one tablet a day, could even be done in the community) – the drugs themselves are really, really expensive. But hopefully the second part will change.

Well, if you wait for patents to expire the drugs will certainly get cheaper. But how many Hep C sufferers will die in the meantime, or suffer through a course of interferon?

Well, if you wait for patents to expire the drugs will certainly get cheaper. But how many Hep C sufferers will die in the meantime, or suffer through a course of interferon?

Some of the most gravely ill are being treated on Gilead's compassionate programme, but yeah. The fact that there are now three companies with products will help add some competitive pressure, but there's a crunch coming. Like I said, I don't envy Pharmac – every dollar committed here is one they don't have to put elsewhere.

Reading some of the stories linked to above, I'll just add that the "stigma" comes with virus. I still found it my duty to inform any person I was involved with as to the implications of certain contact with me. There were some times that honesty was crucial. I managed to berid mine in 2005/6 and didn't find it as difficult as some made out but I had a lot of support and being thick skinned I didn't worry about other peoples negative shit. I also tried to continue my life as normal as possible while on treatment, with the only change being no alcohol . Now my liver is good and alcohol is back on my menu albeit in moderation. The weight loss I considered a bonus. So if the 12 month programme is all that someone can access now ,I'd say give it a go.it is worth a try.

So if the 12 month programme is all that someone can access now ,I'd say give it a go.it is worth a try.

People are assessed on mental health grounds before treatment is recommended, and the efficacy rate (70% at best, less with some genotypes) is a factor too. Basically, if you have a history of depression, a year's severe serotonin depletion might be more dangerous than waiting for the new cure. Some people are being advised along those lines already.

Bear in mind its easy to stop the programme if it doesn't work for whatever reason but I know of quite a few who have died waiting for new livers or just died . I was hesitant to start at first but as the efficacy rate increased I changed my mind. All I can say is ,I'm glad I tried and am still here unlike many people I knew.

There is a GDP value the Govt attaches to a productive human life...well, there used to be. ACC once upon a time used to apply it to the cost of a death by accident, to justify their advertising spend. It's certainly more than 100K.

The value of a statistical life is an attempt at "how much do we pay to prevent one death?".

An important tool in the kit when finite resources are being dished out. There is weirdness though, when people might be willing to spend more to prevent road deaths than house fire deaths. Also probably suffers a degree of ad-hoc adjustment.

Interesting piece at The Wireless raises more questions. Quote:

No matter how unpalatable we might find it, people place a hypothetical value on things all the time. If you decide to jaywalk, or to drive at 110km/h, you’ve weighed up the increased risk against the time saved from walking to the nearest crossing or keeping to the speed limit. It’s a cost-benefit analysis like any other; equating time with money is just an adage away.

Oh, and the value was established at $2 million in 1991 :-)

In 2009, BERL put the value of one year of life at $106,600 when calculating the cost to the country of premature death due to alcohol and other drug use: http://www.justice.govt.nz/justice-sector/drivers-of-crime/documents/BERL_-July_2009-_Costs_of_Harmful_Alcohol_and_Other_Drug_Use-1.pdf

TOTAL CURE FOR HEPATITIS WITH CANNABIS OIL
I’m a living proof that Hep C can be cured with Cannabis oil.In 1998 while donating blood I found out I had Hep C.I was told there was no cure back then. I was told to quit drinking alcohol ASAP or would kill me within 10 yrs so I quit drinking,and in 2014 i started to using cannabis oils sent to me by a specialist,I apply it everyday & was told after few months that I was Hep-C free,I asked my specialist if the oil was so fast in treatment & he replied,” If you took care of your liver by not drinking & smoked pot instead then he said it’s quit possible that cannabis oil cure fast” because I never went for any treatment,I was told it cost $20,000+ for the treatments, believe me this gilead company are sick MF'ers, the drug by this same company in vietnam is $900, the cost for this drug in the USA is $84,000. It is a supreme example of the fleecing of America by these scumbag lower than life corrupts pieces of shit. hail to one that,you can contact the specialist that helped me get cure by sending him an email drlovepriest@gmail.com am sure he will receive you request to help,several people have been cured for quite awhile now wish i helped introduced in my hepatitis organisation online. while this is great for us there is nothing really new here to read about,so people,don’t discriminate,educate so more people have a chance of curing this deadly disease that killed my dad.R.I.P Dad! please help pass this message out there through to poor patience who cant afford to pay for medications there is hope and your help in passing this message over call save millions of life out there

Sorry micheall michael, but you are not “proof that Hep C can be cured with cannabis oil”. The effectiveness of any medication cannot be proven through the experience of a single individual. I have no opinion on whether cannabis oil is or is not an effective treatment for Hepatitis C (there is apparently at least some evidence that it might be), but even if it is, your experience does not prove it.

It's easy to write off the big pharmas as fleecing people for their own gain and there is certainly a profit motive. In no small part dictated by the legal responsibilities to the shareholders. But that said the executives of those big pharmas live quite well.

But it really does cost a fortune to develop any new drug, US$billions now. If they don't make a profit then they can't make any new drugs.

There is almost certainly a better way but it likely involves a huge increase in public funded research and hence increased taxes. I'd prefer that path but I am not in the majority.

I don’t envy Pharmac – every dollar committed here is one they don’t have to put elsewhere.

Agreed. I would not be able to sit on that panel and make those choices.

But we can help. If Pharmac had more money the job would be less hard, we can talk to our local MPs and tell them we want to pay for Pharmac's budget to be increased even if it means more taxes.

Bart, I read a book about 15 years ago which claimed that about 50% of Pharma research budget went on trying to replicate a current patented drug with just enough difference to not be covered by the patent but still be effective.

The two goals involved seemed to be replicating a different companies profitable drug so they could get in on the action, or replicating one of their current drugs that were about to run out of patent so they could market and sell a "new" drug which was still covered by patent.

If that's still true, it does rather take some of my sympathy away for their expensive research requirements.

it does rather take some of my sympathy away for their expensive research requirements

I know some of that stuff goes on. And I'm not saying I believe big pharma is ideal way to create drugs, it is certainly corrupted to varying degrees by arseholes in suits.

But whichever way you look at it getting a drug through clinical trials is hugely expensive and somehow someone has to pay for it, personally I'd prefer it was the taxpayer.

BTW that cost is one reason why so much effort goes into making "variants". While it's true that part of the motivation is to extend the profit from patent exclusivity it is also true that it is vastly cheaper to get a variant of an existing drug through approval than to start from scratch.

Fifty thousand people!

Thanks for writing this Russell. What a terrible situation for so many people.

There's two reasons the value of a statistical life doesn't enter directly into Pharmac's calculations. The first is that VSL is really for immediate life/death decisions like road deaths -- it doesn't allow for quality of life or for shortened lifespan. More importantly, though, Pharmac doesn't have the option to spend more money to save more lives -- their drug subsidy budget is set by Parliament, and they can only trade off one drug against another. At $80,000 per person, treating 50,000 people would take five years of Pharmac's entire $800 million/year drug budget.

I just looked up the PTAC minutes (PDF)from last year where Hep C was discussed. They liked the new drugs, but said:

3.16. The Committee noted that the supplier’s submission proposed funding for all chronic hepatitis C patients in New Zealand. Members considered that the pricing proposed in the application would have a very significant fiscal impact and that the supplier had made no attempt to address this fiscal risk.

That's pretty clear.

I hope that with competing products becoming available, the suppliers will negotiate a bit more. Gilead has licensed generic manufacture of the active ingredient of Solvaldi (sofosbuvir) in India for sale to developing countries, which suggests they may be willing to settle for charging what people will actually pay.

The cost of new livers (if so many were available, which they are not) or medical care until the end of their lives for hep C sufferers surely must exceed $80-100,000.

Add to that the (loathsome concept) economic benefit of having those people alive and healthy, and the cost seems a no-brainer if not thinking short-term.

Hep C infection is a cruel lottery. I wonder what the response would be if those people were the desired over-65 voting catchment.

The cost of new livers (if so many were available, which they are not) or medical care until the end of their lives for hep C sufferers surely must exceed $80-100,000.

Oh, it does. It's radically more expensive to fund liver transplants or treat liver cancer than to provide these drugs. But that's how the system works.

I hope that with competing products becoming available, the suppliers will negotiate a bit more. Gilead has licensed generic manufacture of the active ingredient of Solvaldi (sofosbuvir) in India for sale to developing countries, which suggests they may be willing to settle for charging what people will actually pay.

The emergence of "buyers club" networks in Australia, parallel-importing from India, will hopefully add a bit of urgency.

Anyone who has a direct interest in this topic, either on their own behalf or for someone else, may wish to read the below.

I got this advice from a sympathetic and knowledgeable GP after asking on an individual’s behalf. It’s a really clear explanation of the state of play. Feel free to share it if someone asks you about this stuff.

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There’s always a risk buying medicines overseas, but the Indian factories supplying their domestic market usually aren’t too bad.

The way I work, all the HepC patients see a specialist in private or public, have a fibroscan to assess liver scarring, and maybe a liver biopsy as well for the same reason, and then remain closely or loosely in touch with the specialist depending on results and preferences. Sometimes I will do all the monitoring and followup scans, other times the specialist will.

The old drugs were actually pretty useless (low cure/bad side effects) and lots of people opted not to bother, but the newer drugs are quite different, and I think now all my patients have one way or another have used them (mostly thru trials run by Ed G and Auck Uni).

The key point to get across is that the type of drug or combination used, and the dose(s), and the course length all depend on the scarring/cirrhosis level, and the HCV genotype. Without this information it is not possible to give the correct course, and gain optimum benefit and chance of cure. This information can only be obtained from specialist gastroenterology or hepatology services.

If a patient of mine was found to have HepC I would be happy to supervise medication sourced from overseas if:

- I knew the patient well enough
- they had been assessed by a specialist as above
- the treatment plan was written down, plus the monitoring needed

To do this I would refer them for assessment at the liver unit at Auckland Hospital, or to see a specialist in private, and once I had a letter back with the plan we would go ahead.

Your acquaintance needs a proper assessment and treatment plan from a Hepatologist, and if he’s got a good relationship with his GP then it really shouldn’t be a problem.