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Hepatitis C kills more Americans than all other infectious diseases combined

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Re: Hepatitis C kills more Americans than all other infectious diseases combined

#131

Earlier quoted context omitted.

In many other countries getting treated for hepatitis C won't cost you a dime besides your regular health insurance payment. Prices are often negotiated by health insurers and are pretty much guaranteed to be lower for that reason. Depending on what system you are in, you might never even learn what your treatment cost. Not that you should care.

That depends on the treatment and politicians’ willingness to pay for it. Take cystic fibrosis in England: Until this year, modern, highly effective (and, yes, expensive) treatments available for years in the US—covered at low out-of-pocket cost by insurers there—were unavailable through the NHS.

The same was true of hepatitis C in England - even though NICE, the body responsible for assessing what drugs should be available on the NHS, found that the new treatments were cost effective at the price they were being sold for, the NHS balked due to the total cost of curing everyone and refused to offer it to anyone except a handful of patients who already had severe liver damage.

Re: Hepatitis C kills more Americans than all other infectious diseases combined

#132

Earlier quoted context omitted.

Did you ever figure out why you got HepC? Did you conclude that you had it from birth, or did you remember that you stepped on a nail while traveling in Vietnam?

Yes, I got it from a blood transfusion when I was a child. The Hepatitis C virus wasn't identified until 1989, and blood bank wasn't wide spread until early 1990s, so anyone who received a blood transfusion before then is at risk.

There are quite a few adults today who might not realize or remember receiving blood transfusions as young children. It's worth asking your parents, and when in doubt get tested.

Re: Hepatitis C kills more Americans than all other infectious diseases combined

#133
post #2

Antiviral drugs for hepatitis C are very effective, but they come at a steep cost. Just one Sovaldi pill costs $1,000. A full 12-week course of treatment with this drug costs $84,000. The price of other hepatitis C drugs is also high: Harvoni costs $94,500 for a 12-week treatment Mavyret costs $39,600 for a 12-week treatment Zepatier costs $54,600 for a 12-week treatment Technivie costs $76,653 for a 12-week treatmen…

If you are talking about a virus only affect small amount of population, I can understand this marketing strategy.

But Hepatitis C. is a virus infects 143 million, which means it even with a $10k profit margin for one in ten here should be at least $1 Trillion profits. A company like BMS do expanding like $20 billion annually. For me all most like they could afford to operate like half of century for just one drug. No way it is sold for almost $100k price for just breaking even.

Correct: Sorry it was Gilead Science developed Harvoni. So $22B revenue minus $8 operating incoming.

Re: Hepatitis C kills more Americans than all other infectious diseases combined

#134

Earlier quoted context omitted.

Yes, I got it from a blood transfusion when I was a child. The Hepatitis C virus wasn't identified until 1989, and blood bank wasn't wide spread until early 1990s, so anyone who received a blood transfusion before then is at risk.

So you WERE in the high risk group after all, you can't advice anyone out of the risk group to start using unnecessary medical procedures.

They probably didn't realize they were in the high risk group until the diagnosis since the transfusion was so long ago. Even just talking to a doctor about screening tests can still be helpful since they will likely ask "have you ever received a blood transfusion" if you are asking about Hep C.

Re: Hepatitis C kills more Americans than all other infectious diseases combined

#135
post #124

Earlier quoted context omitted.

Surely, there is room for optimization, but in the alternative case of taxpayer funded healthcare, I'm sure the government is going to ask doctors for justifications for the same reasons insurers do. Someone needs to provide a second opinion on whether or not procedures and medications are appropriate for accountability purposes.

Governments add far less overhead in this area because they have more data and can thus use random inspection of bills for validation. Further, when setting rates every insurer has a separate negotiation involving even more overhead.

The government hires health insurance companies to do the inspections. I don't know of any US government that doesn't contract implementation of Medicaid/Medicare to UHG/Anthem/Humana/etc. So all the insurers have all the data anyway, and they are not inspecting each and every bill, they are also using heuristics.

Re: Hepatitis C kills more Americans than all other infectious diseases combined

#136
post #15

Earlier quoted context omitted.

They're priced this way because they're 80-90% cheaper than the previous treatment. Previously, with no cure, HepC patients would have eventually had a liver transplant. Liver transplants cost between $500K-$1M. Of course, it also requires a liver, so many would die waiting for a liver. As you noted, the drugs have become much cheaper. Mavyret is ~1/2 the cost of Sovaldi, the first drug on the market (replaced by Har…

>> They're priced this way because they're 80-90% cheaper than the previous treatment. Your statement is true. But it also hints at another problem, which is that the default is to price life saving treatments as high as the market will bear. It's a pricing model in line with extortion, the only exception being that the extortionist doesnt have to threaten to kill you - the virus or whatever condition is already maki…

With new drugs you can make the argument that development costs need to be recovered while they are still under patent protection. Time and cost of development is high, 10 - 15 years and several billions, and a successful outcome is not guaranteed. This is the order of magnitude of a flagship space program of a large nation.

Where you really have no excuse is the price for old drugs that get bought up by venture capital. Wilson's disease is treated with triethylenetetramine. The price had always been ~ USD 600 for 100 pills until the manufacturer became bought out by Valeant, who then raised it to 20 kUSD for 100 pills. There was the usual protestations by Hillary Clinton and other politicians, but the price is still where it is. Where is the revolution?

Re: Hepatitis C kills more Americans than all other infectious diseases combined

#137
post #19

Does anyone know what research is being done on creating the vaccine and what are the causes that prevented creating one?

Wikipedia has a brief summary, but it is a similar issue as we see with colds and HIV: a highly variable exterior shell for the virus. About six years back, scientists found one region that is mostly "conserved," the docking station that latches onto a particular receptor in liver cells. Hepatitis C, like HIV, comes in different groups, and it has six to target.

Thanks a lot, that explains the struggle.

Re: Hepatitis C kills more Americans than all other infectious diseases combined

#138

Earlier quoted context omitted.

Yes, I got it from a blood transfusion when I was a child. The Hepatitis C virus wasn't identified until 1989, and blood bank wasn't wide spread until early 1990s, so anyone who received a blood transfusion before then is at risk.

So you WERE in the high risk group after all, you can't advice anyone out of the risk group to start using unnecessary medical procedures.

"Don't take medical advice from strangers on the Internet." is an important rule, but "Get a yearly physical." is hardly controversial or high-risk advice, eh what?

Re: Hepatitis C kills more Americans than all other infectious diseases combined

#139

Earlier quoted context omitted.

>> They're priced this way because they're 80-90% cheaper than the previous treatment. Your statement is true. But it also hints at another problem, which is that the default is to price life saving treatments as high as the market will bear. It's a pricing model in line with extortion, the only exception being that the extortionist doesnt have to threaten to kill you - the virus or whatever condition is already maki…

With new drugs you can make the argument that development costs need to be recovered while they are still under patent protection. Time and cost of development is high, 10 - 15 years and several billions, and a successful outcome is not guaranteed. This is the order of magnitude of a flagship space program of a large nation. Where you really have no excuse is the price for old drugs that get bought up by venture capi…

Do development costs really need to be recovered through sales? I thought most of this research was done on federal grants.

Re: Hepatitis C kills more Americans than all other infectious diseases combined

#140
I’m working on direct-to-consumer STD testing in JasonHealth.com . Some thoughts on Hep C testing:

Hep C Antibody is a very inexpensive test. We charge $25 for it.

It takes a long time for the body to produce the antibodies after infection. This test is only 90% sensitive after 12 weeks ( https://www.hepatitisc.uw.edu/go/screening-diagnosis/acute-d... ). Testing shortly after possible infection with this test is not effective.

The best early detection test is Hepatitis C Viral RNA, Quantitative, Real-Time PCR. It’s able to detect infection 2 weeks after.

The absolute best testing protocol after suspected infection is what doctors use for needle-stick. Test the person who may be spreading the infection immediately using the RNA test. If RNA is detectable start the short course of Hep C drugs on the person who might be infected. This will avoid acute Hep C infection altogether.

Hep C testing is very popular direct-to-consumer. For us, patients usually get it as part of full STD screening ( https://www.jasonhealth.com/l/std-testing ). About 80% of Hep C tests are ordered as part of that.

Anecdotally, it’s not usually ordered by MDs as part of STD screening. Hopefully, these new guidelines will change that.

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