Chronic Hepatitis C (CHC) Treatments By Genotype
By: William Mader, R.Ph.
Summary
Harvoni has been the most utilized treatment for Hepatitis-C due to being effective against genotypes 1, 4, 5 and 6 which accounts for approximately 75 – 80% of the infected population and has been used by over 250,000 Americans since its release in November 2014. However, the recent approval of Epclusa tablets by the FDA introduces effective treatment for all six genotypes of the Hepatitis-C virus and will mean that it has the potential to become the most prescribed with a therapy similar in regimen to Harvoni (one tablet a day for twelve weeks). Epclusa is also effective if the patient has cirrhosis of the liver, and can be taken along with ribavirin if the cirrhosis is decompensated. Epclusa is also more cost effective at an AWP of $89,700 for 12 weeks of therapy compared to $113,400 for Harvoni.
The table below is provided as a quick reference of the various drug therapies, the genotype(s) the drug treats along with the dose for treatment naïve patients without cirrhosis as well as the cost per daily dose. Please refer to the genotype chart below for specific dosing, length of therapy and total cost of therapy.
Background
Hepatitis C is a viral disease that causes inflammation of the liver that can lead to diminished liver function or liver failure. There are at least six distinct HCV genotypes, or strains, which are genetically distinct groups of the virus. The genotype needs to be identified through a blood test, because knowing the genotype helps inform treatment recommendations and the duration of treatment.
Approximately 75 percent of Americans with the Hepatitis C virus (HCV) have genotype 1 and 20 to 25 percent have genotypes 2 or 3; with a small numbers of patients are infected with genotypes 4, 5 or 6.
According to the Centers for Disease Control and Prevention, HCV infection becomes chronic in approximately 75 to 85 percent of cases.
Patients who suffer from chronic HCV infection over many years may have complications, such as bleeding; jaundice (yellowish eyes or skin); fluid accumulation in the abdomen; infections; liver cancer and death.
Monitoring
Serum HCV-RNA, which measures the amount of virus in the blood, should be performed before treatment begins which is considered at baseline, during treatment, to monitor the effectiveness of the therapy, at the end of treatment, to determine if the virus has been eliminated, during treatment follow-up, and when clinically indicated. If used in combination with ribavirin, pretreatment and monthly pregnancy tests up to six months following discontinuation of therapy for women of childbearing age should be performed.
Medication Therapies
The below listed therapies are based on a treatment-naïve patient population which means that no previous therapies have been tried, and are provided based on the Hepatitis – C viral genotype, for which the medication is approved, as well as the therapy used for treatment if cirrhosis of the liver is involved as either compensated (mild) or decompensated (more severe).
Cost
All costs listed are based on Average Wholesale Price.
Ribavirin cost is based on 1,200 mg daily dose (six capsules / day) using the average AWP for 200mg generic products.
Cost of Chronic Hepatitis C (CHC) Treatments by Genotype, pdf