Submitted by Pat Nugent
Only a few years ago, stories appeared in the media about how tens of thousands of U.S. veterans were infected with hepatitis C and that the government couldn’t afford to treat them. Typical was a CBS Newsreport headlined “VA can’t afford drug for veterans suffering from hepatitis C”. The drug in question was Gilead’s Sovaldi, a once-a-day pill that remarkably can cure hepatitis C over a 12 week regimen. The concerns being raised by the press was that Sovaldi cost $1,000/pill – a cost that could cripple the VA’s budget if all of our veterans were to be treated.
The issue was especially timely. These veterans, many of whom contracted the disease during their service in the Vietnam War as a result of battlefield injuries requiring blood transfusions, were now suffering from the consequences of this largely silent menace. They were now experiencing liver disease, cirrhosis and liver cancer. Without Sovaldi, the sicker of these patients were facing certain death.
Fast forward to last Friday. At the 24th Annual Wharton Health Care Business Conference, Dr. David J. Shulkin, the Secretary of the U.S. Department of Veterans Affairs, announced that the VA was on track to eliminate hepatits C infections in the next 12 months for those who are willing and able to be treated. In October 2014, the VA had over 146,000 veterans afflicted with hepatitis C. By next October, this number will be only 20,000.
How did this happen? Here’s the VA’s response as contained in their 2018 Budget in Brief:
In 2014, VA began a ground-breaking system of care for Veterans with the Hepatitis C Virus (HCV). The Food and Drug Administration approved two new, highly-effective drugs – Sofosbuvir (Sovaldi) and Simeprevir (Olysio) – that work to change the lives of Veterans infected with Hepatitis C. Prior to the introduction of the new high-cost treatments therapies in the VA system in January 2014, treatments for Hepatitis C were often ineffective and presented considerable side-effects. By contrast, the new treatment options are considerably more effective than earlier options, and are much easier to administer. Cure of HCV significantly decreases the risk of progression of the disease to cirrhosis, liver failure, liver cancer, and death. VA wants to ensure that all Veterans eligible for these new drugs, based on their clinician’s recommendation, receive the medication.
But what about the high-cost of these drugs? While the retail price of Sovaldi was $84,000 at launch, the VA is allowed by law to negotiate drug prices. In addition, other hepatitis C cures have been brought to market over the intervening years such as AbbVie’s Viekira Pak and Merck’s Zepatier, thus putting purchasers in a good negotiating position. Here’s how the VA described drug costs in their 2018 Budget in Brief:
VA successfully worked with the manufacturers of these drugs to receive a reduced price for their use to treat Veterans. VA estimates the drugs will cost $748.8 million and provide 31,200 treatments in 2017 and costs increasing to $751.2 million for 28,000 treatments in 2018.
If you quickly do the math, 59,200 U.S veterans will be cured of hepatitis C for roughly $25,300/soldier. That’s remarkable and a far cry from the concerns being raised less than four years ago.
This is a great story. Thanks to the VA’s commitment as well as the innovation on the part the manufacturers, a major health issue for our veterans will be eliminated. Hopefully, the press will be motivated to cover this story as diligently as they did in 2014.