How expensive does hep C treatment get?
I presume then combination therapy is much more effective than monotherapy?
Yes. Results from two pooled multi-centred trials involving more than 1,700 patients showed 67 per cent of patients infected with HCV other than genotype 1 responded with combination therapy on a sustained basis within 24 weeks, although there was no improvement in this statistic if treatment was continued.
For those patients who had genotype 1 HCV, this figure was only 17 per cent, although this rose to 28 per cent after 48 weeks' treatment.
Discontinuation of treatment was more common in combination therapy than monotherapy, reaching up to 20 per cent discontinuation. This was mainly due to haematological problems or side-
effects including anorexia, alopecia, psychiatric disturbance or altered thyroid function.
Obviously there are major cost implications here
As with much in the NHS, this could be a stumbling block. The National Institute for Clinical Excellence looked at this point, and its guidelines on combination therapy state that six months of this treatment costs some £4,800, excluding monitoring, counselling and infrastructure costs.
Fairly crude calculations suggest some 7,000 people would initially be offered treatment if guidelines were followed, and drug costs would amount to some £55 million over three years of treatment. Viral genotyping and monitoring, counselling and other pre-treatment services would all need to increase substantially and so this costing would appear an underestimate. There also may be a knock-on factor into primary care especially in counselling where extra training may be required.
NICE intends to review its clinical guidance on combination treatment in October when the cost-benefits of once-weekly pegylated interferon will also be considered. This may be more effective than earlier forms of interferon, especially in patients of genotype 2 and 3, but only time will tell.