Hepatitis C Has A Cure, But You Can't Have It

By Cedric Voets · June 08, 2018
Direct-acting antivirals, or DAAs, are a type of drug that attack proteins in viruses and messes up their replication, causing them to die out -- like a microscopic Children Of Men. Since 2014, there's been a DAA that has over a 90 percent cure rate for hepatitis C, the chronic blood infection that hits the liver and is the scourge of healthcare workers, the exuberantly frisky, and legendary baseball players. If 260,000 sufferers in the U.S. were to undergo the DAA regimen every year, the country would be Hep-C-free by 2030. It's such a great idea that even the slogan writes itself. But the healthcare industry would disagree on that.

Despite vocal outrage by medical professionals and even successful class-action lawsuits against insurers, most hepatitis C sufferers aren't getting the DAA cure. Private insurers flat out deny over half of DAA prescriptions, with patients on Medicare and Medicaid faring somewhat better. Worse, the number of denials seems to be rising. The insurers' reasoning for denial is simple: With a cure that costs up to $100,000, it's just too expensive to give to everyone. So they tend to only grant it to those on the brink of death. So somehow, most people with hepatitis C aren't eligible for the cure for hepatitis C. That sounds less like a real-life situation than a quote from a Catch-22 sequel called You Catch It, You Keep It.

But why does Big Pharma make such an important cure so expensive in the first place? Depressingly, it all comes down to basic supply and demand. Don't take our word for it, but that of a Goldman Sachs analyst. In a report titled "The Genome Revolution," she posited that it's just bad business to actually cure people of what ails them, and she even used the DAA treatment for hepatitis C as a model. When the cure first came out, Big Pharma was able to sell $12.5 billion worth of it. But then the pesky thing started reducing their customer base (i.e. healing them), and now their profits have gone down to a paltry $4 billion. If that downward trend holds, soon they'll actually run out of hepatitis C to cure! If you can't turn saving lives into a sustainable business model, why even bother?

For some, a painful disease. For others, the stuff that bought them a yacht.

That's some ruthless math right there -- about as ruthless as, say, maybe figuring out which percentage of patients you should hypothetically deny a cure to so that their highly infectious disease never runs the risk of being wiped out and your expensive cure can remain profitable. Not that we'd ever accuse the same industry that performs illegal experiments, bribes doctors to get them to dangerously over-prescribe, and makes billions off cures for drugs they created. That would be very unlike them indeed.

Genetics
Goldman Sachs Analysts Question Whether Curing Patients Is Good for Business
Kristen V. Brown
4/13/18 2:44pm
Filed to: Genetics

Will business stand in the way of gene therapy?Photo: Penn Medicine
Recent advancements in science and medicine have put cures within reach for diseases that have long plagued humankind.

In a recent report, though, Goldman Sachs analysts posed an uncomfortable question that quickly sparked criticism.

"Is curing patients a sustainable business model?" analysts asked in an April 10 report entitled "The Genome Revolution," which CNBC first reported.
One-and-done cures enabled by gene editing, analyst Salveen Richter wrote in the note to clients this week, are near-miraculous innovations that stand to benefit patients immensely.

But they also present a challenge to business.
"While this proposition carries tremendous value for patients and society, it could represent a challenge for genome medicine developers looking for sustained cash flow," she wrote.

The trouble is, it's hard to reap long-term profits when you're actually curing the patients who would buy your treatment.

The report points to Gilead's treatments for hepatitis C, which cure more than 90 percent of patients. In 2015, at the height of sales, US sales of the drug hit $12.5 billion. But as people have been cured, sales have fallen. Goldman estimates US sales for Gilead's hepatitis C treatments will be less than $4 billion this year.

"[Gilead] is a case in point, where the success of its hepatitis C franchise has gradually exhausted the available pool of treatable patients," the analyst wrote. "In the case of infectious diseases such as hepatitis C, curing existing patients also decreases the number of carriers able to transmit the virus to new patients, thus the incident pool also declines… Where an incident pool remains stable (eg, in cancer) the potential for a cure poses less risk to the sustainability of a franchise."

Cutting-edge gene therapies, which are often pitched as one-time cures and on top of that often target small groups of patients, present the same risk.

The MIT Tech Review points out that that this may have been the impetus behind GlaxoSmithKline's announcement today that it will sell off its pipeline of gene therapies for rare disease to London gene-therapy upstart Orchard Therapeutics for a 20 percent stake in the company. One of those therapies is Strimvelis, a cure for a rare immune deficiency often called "bubble boy" disease. But even with the hefty price of $665,000, the small patient population means that the cure didn't look like it would amount to much of a business.

It's a callous calculation, and it shows that bringing to fruition the promises of the gene-editing revolution will take a lot more than mere scientific breakthroughs.

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It's about time that *some* business practices need to be reigned in. I think that most/all political parties would agree. It's HIGH TIME ...