a cheaper way to cure hep c?

A lot of attention has been given recently to the new drug Sovaldi.  In case you don’t remember, it’s the really expensive drug used to treat Hepatitis C (hep c).  Let’s get this out of the way up  front: the drug is revolutionary.  It has phenomenal cure rates, compared to the previous standard of care.   The real reason that it made news, though, was because of its cost.  The quoted figure is $84,000 for a course of treatment, and yes, you can buy a modest house, or a really sweet car for that much.  Of course, anyone who has spent time with pharmacy benefit managers (drug insurance companies) understands that NO ONE is paying $84,000 for a course of treatment.  I’ll give the world a lesson in how drug pricing works at another point in time.  For now, just trust me: it will cost less.

According to a recent study by Express Scripts Inc (that I found via twitter), the state governments could be on the hook for up to $55 Billion of hep c treatment.  One fact I found particularly striking was, “(California) is expected to spend $6.6 billion if it treats all 93,000 of its Medicaid enrollees and prisoners who are estimated to have chronic hepatitis C.”  If you want to see the math, you can check it out here http://bit.ly/1tfYabG.  Expensive for sure, but this is a disease state that has significant medical and economic consequences for its sufferers.  Sovaldi is a good drug, and I believe, if used appropriately and en mass, we could theoretically begin to stamp out Hepatitis C.  With the cure rates for a viral disease so high, it’s not improbable to think we could eliminate the disease from the United States.  Think about that: eradication of a disease we have struggled with since it was identified over 25 years ago.

To accomplish that we have to think of this agent, not as a treatment for the sick, but as a vaccine.   Now technically, this isn’t a vaccine.  Not even close.  It doesn’t stop someone from getting hep c, and it only works if you’re already infected.  It does effectively reduce the number of infected patients in the population.  By lowering the number of infected, the risk of contraction is lower.  As you drive both the number of infected down, and the number of newly infected down, you reach a point (ideally zero) where the disease is eradicated.

The first question you may have is, “Why don’t we just treat the symptomatic?”  Fair enough, we do that for lots of stuff.  The problem with that strategy here is that the population of newly infected will continue to persist.  This means the burden of treating the disease will stick with us for much longer if we conducted an all out assault.  By driving down the infected population, the number of people we treat over the next 20 years would be significantly lower.  So my first point towards making hep c cheaper to fight is Use Brute Force.  I’m talking Polio vaccination campaign force.  Drive the infected population down quickly, so we end up treating fewer people.  We don’t eradicate diseases often, so this is not a step to be taken lightly.

If you agreed with that somewhat contentious, point here’s your next question. “How do we pay for it?”  You thought the first part was tough to swallow? Then hold on.  Eminent Domain. I’ll let that soak in for a second.

Now, before people get bent out of shape, I’m not all about the government taking over everything in our lives.  I like my property and I want to protect the rights of citizens and companies, alike.  Additionally, I’m not a lawyer.  This may not even be legal, but I think it’s a radical idea worth considering.  California, the state in which Gilead (the maker of Sovaldi) resides, is on the hook (theoretically) for $6.6B worth of treatment for Hepatitis C.   What if instead of spending the money on treatment, they spent more (probably considerably more) on procuring the ownership of the drug?  Under eminent domain, they could, in my opinion, claim the drug as property in public interest and pay a fair market value.   Today the market cap on Gilead is about $137B, so it would probably be a substantial amount.  By accomplishing this we could begin spreading the treatment across the world in hopes of eradication.  Or we could wait until it goes generic… at a cost of about 350,000 people per year.

As a final note, there are even more effective medications coming to market soon and their cost is unknown.  The same logic applies.  Treat people quickly to drive the population of infected down.  How we do it is irrelevant.  This is a public health situation and not a personal health situation.  Let’s treat it that way.

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