REPORT BACK: 2nd International Meeting Hepatitis Cure & Eradication
december 2, 2015
Presented by: Adam Cook, CTAC Policy Researcher – December 2nd, 2015
On November 11th and 12th this year, Virology Education Inc. hosted its 2nd International Meeting on Hepatitis Cure & Eradication. CTAC Executive Director Shane Patey and Policy Researcher Adam Cook were both in attendance. CTAC has attended conferences organized by Virology Education before and have remarked in the past that their meetings tend to focus more on research and clinical application than policy, community involvement, or patient input. CTAC’s evaluations of these events has urged for more community participation and specifically more speaking opportunities for community advocates, and while this element of Virology Education’s conferences has improved, it is still lacking.
For Canadian stakeholders, the conference began with something of a wake-up call. Several international clinicians took aim at Canada’s HCV treatment eligibility requirements, with many being aghast at how entrenched our policies are in waiting for a patient to incur liver damage before beginning treatment. Egypt’s Dr. Manal El-Sayed argued that, internationally, this question has been answered and that “of course we treat early! Why wait until the patient has advanced liver disease,” and was shocked to learn that Canada still requires patients to wait. Overall, many researchers took aim at eligibility requirements, arguing that HCV’s curable nature meant that we should treat as many as possible, as soon as possible. Australia’s Dr. Margaret Hellard put this point rather elegantly when she declared to the room “who’s the best patient to treat? The one in front of me.” Other researchers echoed this point, arguing in favour of evidence that suggests delaying treatment is not a sustainable strategy in the goal of eliminating HCV in Canada. When pressed for a model or plan, Dr. Hellard further emphasized the simplicity of the problem in responding “how do we prioritize treatment? How about people line up, and then we treat them!” Sobering in its simplicity, Dr. Hellard’s compelling perspective received much reinforcement throughout the conference.
Much of the most interesting new research was summarized very well by Toronto’s own Dr. Jordan Feld, who made a very compelling argument that the state of HCV today has changed considerably, even since the last HCV Eradication meeting (where Dr. Feld helped author the Toronto Declaration). Dr. Feld shared the good news that treatment options have made HIV/HCV co-infected patients a special group no longer. Advances in treatment have meant that while this population traditionally sat in the harder-to-treat group, that is no longer the case, and we now have effective, safe treatment options. Further, we are slowly improving our ability to treat other harder-to-treat populations such as cirrhotics.
Many clinicians tip-toed around the cost of drugs, but Dr. Feld specifically took aim at the health economics of HCV, acknowledging that treatment costs are still prohibitively expensive, but still less so than the cost incurred by not treating. That Sovaldi costs about $100 to make, while charging $55,000 in sales, means that Canada’s not even close to debating ethical profit margins for pharmaceuticals, but rather, that we should be looking more closely at patents, generic medicines, and re-evaluating older direct-acting antivirals (DAAs). For Dr. Feld, the increased competition in the HCV Cure market could hopefully drive prices down, but we may have reached our ultimate efficacy in HCV (drugs that are curing patients in the 95-99% range) and should therefore redirect efforts away from developing new, expensive drugs, and toward finding new public health solutions with cost-effectiveness in mind.
By far the most compelling arguments were made by the sole community speaker, Treatment Action Group’s Tracy Swan. Swan took on the “myth of stampede” as a cost-mitigation tactic, challenging the notion that health care systems would be bombarded with unrealistic costs as HCV sufferers seek treatment en masse. Swan argued that we continue to use similar old wisdom (that we delay treatment because treatment is insufferable; that we wait for a certain amount of liver disease before treating) simply to avoid treatment costs, and that this is inhumane, saying “we don’t let someone bleed to death while we treat their ear-ache.” Rather, present eligibility requirements keep a cure out of the reach of our most marginalized patients: the poor, people who inject drugs, and First Nations. Further, Swan noted that while 80% of new HCV infections are among people who are presently using drugs, there is no evidence to support a positive correlation between sobriety and successful treatment. This is another counter-intuitive position for Swan, who noted “do we tell someone with cancer to quit smoking before treatment?” Perhaps more poignantly, Swan also took aim at adherence concerns when treating people who use drugs, arguing that “no one better understands the impact of missing a dose than someone using injection drugs.” Finally, Swan expressed concern at the lack of work being done on sexual transmission of HCV among Men-Who-Have-Sex-With-Men, calling it a disservice of our health messaging that we do not do more to raise awareness about here.
While most researchers avoided taking on the costs of new HCV medications, Swan pulled no punches, clearly demonstrating how in developed countries, Sovaldi is priced 67 times higher than gold, and that worldwide, 5 grams of daclatasvir will cost the patient more than 5 grams of diamonds.
In a conference full of clinicians whose work was more focused on research, hearing a community response to treatment policy was immediately refreshing and applicable. Perhaps the organizers, Virology Education, could do more to have increased community representation at their next event, so that the voices of patient and community advocates, like Swan, are given the time and forum they deserve. Such testimonies are most useful for clinicians to hear and are, ultimately, the public health application of their research work.
View CTAC's live tweets from the event