Guideline: Patients with liver disease should be first to receive expensive Hep C drugs

Patients with advanced liver disease or other severe symptoms of hepatitis C virus (HCV) infection should be first in line for drug therapy, according to a new guideline from the American Association for the Study of Liver Diseases and the Infectious Diseases Society of America.

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The guideline was created with support from the International Antiviral Society-USA (IAS-USA) to provide evidence-based treatment recommendations to providers in a timely fashion, according to Donald Jensen, MD, director of the Center for Liver Diseases at the University of Chicago.

“We felt that most previous guidelines, particularly those for hepatitis C, took months to develop and publish, occasionally as long as 18 months,” Dr Jensen explained.

“In a field moving as fast as HCV, this time course seemed too slow and would not provide treating physicians and patients with the type of information and recommendations they wanted when they needed them.”

A group of 27 experts in the field of hepatitis C was convened to evaluate the available published information, weigh the strength of the evidence, and provide guidance in an on-line, web-based format coordinated by IAS-USA. 

“Cost is obviously of huge interest to everyone involved in hepatitis C therapy,” he said. “We wish the costs were less. However, in developing treatment guidelines it is not in our purview or role to comment on cost or publish guidelines that are influenced by cost.  They must address the important doctor-patient interaction and the fundamental question of ‘What's the best treatment for this patient?’.  We also understand, however, that not all 3 to 4 million patients in the United States with hepatitis C can be treated immediately, both logistically and for the fact that over 50% have not even been diagnosed. Therefore, we offer a prioritization which is designed to treat first those who are most in need of urgent therapy. We think this is an ethical and justified approach. We do not exclude anyone.”