Monday, August 25, 2014

Just Do It

Waging War on Hepatitis C
All over the country, state governments are grappling with the same question: “What do we do about Sovaldi?” The drug seems to be far more effective than alternatives at treating hepatitis C, a disease that, left untreated, frequently progresses to liver disease and then death. It also costs $84,000 for a course of treatment.

State governments, horrified by the cost, are reacting by slapping restrictions on how -- and in one case whether -- it can be prescribed. Many are limiting it to only the worst cases, those who already have cirrhosis. But this strategy may not work, as Governing magazine points out: Patients can sue, and they probably will.

It strikes me that we are going about this in entirely the wrong way. Instead of complaining about how much Sovaldi costs and trying to tamp down its use, why not use the drug to stage a war on hepatitis C? Why not try to get the drug into as many bodies as possible, as fast as possible, with the hope of knocking this horrible disease back down to much lower infection rates? While Sovaldi doesn’t cure every case of hepatitis C, it cures most of them. And because the disease is actually very hard to acquire, draining much of the disease’s current “reservoir” of victims might help to reduce the rate of new infections to negligible levels.

There are problems with this idea, of course. Many people who have hepatitis C don’t know it, and the disease is rare enough (about 1 in 100 people) that broad screening would probably produce more false positives than true positives, though we could certainly make a lot of progress with just screening known risk groups, such as intravenous drug users and their partners. . . 
I was talking to an infectious disease specialist yesterday, down at the beach (it's funny who you meet on the beach) and we were talking about this. I said it would probably save money in the medium and long run if we just bit the bullet and decided to treat everybody we could find. He agreed, and said the math had been done.

At about 1% of the population, that's approximately 3.2 million people.  At $84,000 a cure that's $268 billion bucks. Yep, that's a lot of dough, approximately 0.5 stimulus package.

But I'm pretty confident if the government promised to buy 3.2 million they could get the price down, way down. And it would take more than a year to do it, so the

We stopped Smallpox, we have all but eliminated polio (and probably would have except for the suspicious Islamic assholes in Pakistan and Afghanistan), and we didn't do by ignoring them, and letting people who couldn't pay go unprotected.

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