I attended the California Technology Assessment Forum (CTAF) session on Genotype 1 Hepatitis C pharmacotherapy today. Unlike the previous meeting, there was considerable evidence regarding cost effectiveness, especially as it involves comparing Harvoni to Interferon/Ribavirin regimens. In fact, it was suggested that in comparing Harvoni to Interferon/Ribavirin in treatment naive patients, it was likely that Harvoni would prove to be cost effective 95% of the time. Furthermore, clinicians expressed strong belief that interferon use will be drastically reduced due to its negative side effect profile. The panel voted 12-0 that Harvoni was clinically superior to Interferon/Ribavirin regimens in Genotype 1 patients. Furthermore, 11 of the 12 panelists voted that Harvoni had a reasonable or high care value versus Interferon/Ribavirin. However, 10 of the 12 panelists felt that the health system value of Harvoni for a state Medicaid program was low. Several clinicians and panelists expressed the view that it would be beneficial for all Gentype 1 treatment naive patients to receive pharmacotherapy.
In talking with clinicians and insurers regarding the AbbVie regimen, they were favorably inclined, especially in Genotype 1b patients and certain other subsets. Interestingly, they expected AbbVie to price its regimen at a slightly greater discount than I believe is expected by Wall Street analysts. They view AbbVie's primary opportunities as being in Genotype 1b and state Medicaid programs.
Overall, I sensed a greater recognition as to the clinical efficacy and cost benefit of the newer direct acting antivirals. Concern regarding overall cost remains an issue, especially for state Medicaid plans. The interesting, soon-to-be answered issue is AbbVie's pricing for its regimen.
See: Original Gilead article.
Disclosure: The author is long GILD.
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