Drug Pricing Evolution in Hepatitis C.
OBJECTIVE
We aimed to determine the association between the stepwise increase in the sustained viral response (SVR) and Swiss and United States (US) market prices of drug regimens for treatment-naive, genotype 1 chronic hepatitis C virus (HCV) infection in the last 25 years. We identified the following five steps in the development of HCV treatment regimens: 1) interferon (IFN)-α monotherapy in the early '90s, 2) IFN-α in combination with ribavirin (RBV), 3) pegylated (peg) IFN-α in combination with RBV, 4) the first direct acting antivirals (DAAs) (telaprevir and boceprevir) in combination with pegIFN-α and RBV, and 5) newer DAA-based regimens, such as sofosbuvir (which is or is not combined with ledipasvir) and fixed-dose combination of ritonavir-boosted paritaprevir and ombitasvir in combination with dasabuvir.


METHODS
We performed a linear regression and mean cost analysis to test for an association between SVRs and HCV regimen prices. We conducted a sensitivity analysis using US prices at the time of US drug licensing. We selected randomized clinical trials of drugs approved for use in Switzerland from 1997 to July 2015 including treatment-naïve patients with HCV genotype 1 infection.


RESULTS
We identified a statistically significant positive relationship between the proportion of patients achieving SVRs and the costs of HCV regimens in Switzerland (with a bivariate ordinary least square regression yielding an R2 measure of 0.96) and the US (R2 = 0.95). The incremental cost per additional percentage of SVR was 597.14 USD in Switzerland and 1,063.81 USD in the US.


CONCLUSIONS
The pricing of drugs for HCV regimens follows a value-based model, which has a stable ratio of costs per achieved SVR over 25 years. Health care systems are struggling with the high resource use of these new agents despite their obvious long-term advantages for the overall health of the population. Therefore, the pharmaceutical industry, health care payers and other stakeholders are challenged with finding new drug pricing schemes to treat the entire population infected with HCV.
Medical Direction, Geneva University Hospitals, University of Geneva, Geneva, Switzerland.|Finance Direction, Geneva University Hospitals, Geneva, Switzerland.
Nathalie
N
Vernaz
Medical Direction, Geneva University Hospitals, University of Geneva, Geneva, Switzerland.|Division of Clinical Pharmacology and Toxicology, Geneva University Hospitals, University of Geneva, Geneva, Switzerland.
François
F
Girardin
Divisions of Gastroenterology and Hepatology, Geneva University Hospitals, University of Geneva, Geneva, Switzerland.
Nicolas
N
Goossens
Winterthur Institute of Health Economics, Zurich University of Applied Sciences, Winterthur, Switzerland.
Urs
U
Brügger
Winterthur Institute of Health Economics, Zurich University of Applied Sciences, Winterthur, Switzerland.
Marco
M
Riguzzi
Medical Direction, Geneva University Hospitals, University of Geneva, Geneva, Switzerland.|Division of General Internal Medicine, Geneva University Hospitals, University of Geneva, Geneva, Switzerland.
Arnaud
A
Perrier
Divisions of Gastroenterology and Hepatology and of Clinical Pathology, Geneva University Hospitals, Geneva, Switzerland.
Francesco
F
Negro
D000998:Antiviral Agents / Q000191:economics* / Q000627:therapeutic use; D003362:Cost-Benefit Analysis; D055808:Drug Discovery / Q000191:economics; D004359:Drug Therapy, Combination / Q000191:economics; D005838:Genotype; D016174:Hepacivirus / Q000187:drug effects*; D006526:Hepatitis C / Q000188:drug therapy* / Q000191:economics* / Q000453:epidemiology / Q000821:virology; D006801:Humans; D007372:Interferons / Q000191:economics / Q000627:therapeutic use; D009842:Oligopeptides / Q000191:economics / Q000627:therapeutic use; D012254:Ribavirin / Q000191:economics / Q000627:therapeutic use; D019438:Ritonavir / Q000191:economics / Q000627:therapeutic use; D000069474:Sofosbuvir / Q000191:economics / Q000627:therapeutic use; D013557:Switzerland / Q000453:epidemiology; D014481:United States / Q000453:epidemiology
D000998:Antiviral Agents; D009842:Oligopeptides; D012254:Ribavirin; C486464:telaprevir; D007372:Interferons; D019438:Ritonavir; D000069474:Sofosbuvir