Post treatment results

[Mike]

I just had my 1 year follow up with my GI and I'm still undetected , which means I've been virus-free for 1-1/2. My GI cut me loose, indicating that there wasn't anything else he could do for me.

We had a discussion about the current treatments and he states that almost everyone he treats is being cured. This is great news! These new medications are really game changers!

Of concern, however, is that my GI qualified the great cure rates with "if they get approved by the insurance company," and we both voiced concerns about this.

The other issue my GI brought up, is that a lot of young drug users are coming in and testing positive for HCV, which is a very unfortunate trend and directly related to the opiod/heroin  epidemic in this country.

We discussed the treat-all model; but we both had concerns with the treatment of an active IV drug user, feeling that a minimum of 6 months sobriety  was a good rule.

The reasoning behind this is why treat an individual that may very well become reinfected after 12 weeks of treatment and continue to spread the virus?

Any thoughts?

Best wishes, Mike

[Else]

Congratulations on your one-year anniversary of a successful cure!

The treat-all model is what is supported by the AASLD and the IDSA.  Of course, the cost of treatment is what calls this model into question.  So on August 20th of this year the HCV guidelines were amended to clarify (as much as is possible where "nondisclosure of pricing agreements" are the norm for insurance companies) the true cost of treatment.

http://www.hcvguidelines.org/full-report/overview-cost-reimbursement-and-cost-effectiveness-considerations-hepatitis-c-treatment

Of specific note:

With the exception of mandated rebates, negotiations of drug prices are considered confidential business contracts and, therefore, there is almost no transparency regarding the actual prices paid for hepatitis C drugs. (Saag, 2015) However, the average negotiated discount is reported to be 46% off the WAC in 2015, implying that most payers are paying well below the WAC price for HCV regimens. (The New York Times, 2015)

46%!  That infamous $1000 pill?  It doesn't exist.  If doctors knew that the actual cost of treatment was more in line with the cost of a hip replacement, the sticker shock and tendency to "warehouse" patients would change significantly.

Here's a link to a doctor's submission to the journal "Clinical Liver Disease".

http://onlinelibrary.wiley.com/enhanced/doi/10.1002/cld.490  You can see how his practice guidelines are driven by the cost and not the efficacy of the new medications.  And he doesn't have the costs right.    Here is his conclusion (that was read by who knows how many other doctors):

Thus, as providers, for patients with early stage disease, our only recourse is to acknowledge that the HCV cure is available, but you will have to get sicker to get better. In other words, it's back to the warehouse for now

No.  One does NOT have to get sicker to get better.  The misinformation out there is appalling. 

on edit - regarding IV drug users.  Why treat someone who may likely continue to expose themselves to reinfection?  Because to not do so is to knowingly send someone out to infect others.  Yeah, they shouldn't.  But they will.  It's a lousy situation, no argument there.  But at the time of an HCV diagnosis it would be a really good idea to educate a user on existing needle exchange programs or to implement one.  And of course, of course to lobby hard for treatment for addiction. 

[Mike]

6 months sobriety seems to be the consensus when dealing with an active IV drug users.

Knowingly exposing others to communicable diseases is a criminal offence. Once the addict knows his or her status - it's on them - not the doctor.

Makes sense to me.

Best wishes, Mike