The World Health Organization’s first guidelines on the treatment of hepatitis C released Wednesday begin by noting that while treatment for the virus is successful for most of the people who receive it, 350,000 of those infected each year. Most of the more than 185 million people living with the chronic viral infection remain undiagnosed, the document notes, while treatment remains out of reach for many who have been diagnosed.
The guidelines seek to address those challenges, with recommendations that include expanding both screening and testing for the virus among people at high risk of exposure to the blood-borne infection, and treatment with the new, shorter course and more easily tolerated oral medicines sofosbuvir and simeprevir. But while the guidelines strongly recommend the two medicines based on “high quality of evidence,” (other drugs are recommended on “moderate quality of evidence”) the document notes that those recommendations were made without information on pricing of the drugs in any country but the United States. And in the United States, a price tag of about $84,000 for a course of treatment with Sovaldi, the brand name for sofosbuvir, would mean that treatment for all who needed it would exceed the amount currently spent nationwide on all prescription medicines. As noted here, drugmaker Gilead has announced plans to make the treatment available for lower prices in middle-income countries, but those prices would still set the cost of medicine alone beyond multiples of those countries’ entire health budgets. Médecins Sans Frontières has pointed to a study showing that a course of sofosbuvir treatment could cost as little as from $68 to $136. The organization released a statement welcoming the guidelines and calling for the lifting of patent barriers to the drugs’ accessibility. At the same time the statement calls for increased funding on both national and global levels to put the guidelines into effect.
The guidelines also call for integrated treatment for patients co-infected with HIV and hepatitis C, and comprehensive harm reduction efforts (which include provision of clean syringes and opioid substitution therapy) among people who use injecting drugs.