A one-thousand dollar per day drug bargain? HCV bites the dust?

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Eyebrows across the US must have gone up a few notches after Gilead just announced that Sovaldi, its revolutionary drug for hepatitis C would be priced at $1,000 per pill (!). Is this as bad as it seems? Maybe not.

Although the hepatitis C virus (HCV) is much less well-known than HIV, its worldwide prevalence is roughly four-times greater, including 3.2 million infected people in the US alone, and 150 million worldwide. Furthermore, many people who have Hepatitis C don't know it. (This explains the rationale behind the CDC's recommendation that all baby-boomers get tested for the virus).

And in the US, within the past two years, because of the combination of exquisitely effective HIV drugs and the absence of the same for HCV, there are now more deaths per year in the US from HCV than from AIDS. Furthermore, Hepatitis C is the leading cause of liver transplants in the US.

The virus is transmitted almost exclusively by blood, including IV drug use, transfusions, tattoos, careless handling of blood in pre-HIV days, and rarely, sexually.

Before the approval of specific antiviral drugs for HCV, choices were limited and poor. The standard of care included injections of the immune stimulant interferon, a drug with such severe side effects that many patients simply discontinued treatment, effectively committing pharmaceutical suicide. Additionally, the cure rate (unlike HIV, HCV can be cured) was typically in the 40-50 percent range.

In 2012, both Vertex and Merck launched the first specific anti-HCV drugs. Although these drugs significantly increased cure rates, they had their own set of toxicity issues. Furthermore, they were added to the interferon therapy rather than replacing it.

Despite leading the way in the anti-HCV battle, Vertex and Merck themselves became casualties of the HCV war, as a number of companies were a couple of years behind in the race, but with superior drugs Gilead s Sovaldi being one of them.

But Sovaldi was worth waiting for. Trials have shown that with Sovaldi alone - and even better when combined with other drugs awaiting approval - cure rates approach 100 percent in the absence of interferon. The holy grail of HCV therapy is finally at hand, more than two decades after research began.

What about the price?

ACSH s Dr. Josh Bloom says, I think it s a damn fine deal. Of the 40-plus drugs approved in 2012, mostly of them were in the $50-$100 thousand per year range, with some being much pricier. Many of these were cancer drugs, which typically offered about 6 months of extra life (and sometimes far less).

He continues, A full course of Sovaldi ($84 thousand over 12 weeks) performs a miracle an actual cure for the disease. And when compared with the cost of previous less-effective therapies (about $25,000) or a liver transplant (about $500,000), this begins to sound like quite a bargain.

It is rare to find such an effective treatment for a previously refractory disease. It has been estimated that Sovaldi may become the best selling drug in history, surpassing even Lipitor.

Gilead will be rewarded many times over for their persistence and first-rate science.

Dr Bloom says, Good for them. They deserve every bit of it.