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Current HCV meds fading as Epclusa comes in
Posted 1 August 2017
PBS figures show that pre-rebate benefit earnings on the top three HCV drugs are rapidly falling as Gilead's new pan-genotypic option, Epclusa (sofosbuvir/velpatasvir) is PBS listed today, but experts give different reasons why.
Harvoni (ledipasvir/sofosbuvir) dropped from $194 million to $162 million from the first to second quarter this year while Sovaldi (sofosbuvir) declined from $240 million to $174 million and Daklinza (daclatasvir) $77 million to $65 million during the same period.
Harvoni was down by close to 61 per cent in the quarter to June this year as compared to the same period in 2016 while Sovaldi was down by 33.6 per cent and Daklinza by 32 per cent.
Hepatitis Australia CEO Helen Tyrrell doesn't see the decline as a result of 'warehousing', that is, patients being made to wait for the new, more convenient, pan-genotypic Epclusa.
"The warehouse is empty," she said. Although there was a massive number of people who were holding off prior to the first PBS listing in March last year, that base population of highly engaged patients from liver clinics - roughly 40,000 - has now been treated.
"We've got to go looking for them now," Tyrrell said.
These patients includes those for whom the disease is not foremost in their mind, including those who have injected drugs decades ago, are showing no serious symptoms and, combined with societal stigma, have their "head in the sand".
She said there was a need for multiple strategies including focusing on priority populations in prisons.
But the treatment drop-off, which she describes as the "waterfall effect" and which has often been cited as a major business headache for Gilead, comes as no surprise.
"We knew there would be this impact of a massive surge and then a drop-off," she said.
Professor Greg Dore, head of the Viral Hepatitis Research Program at the Kirby Institute, University of NSW, sees the fall as the result of a more nuanced combination of events, including the introduction of MSD's Zepatier (elbasvir/grazoprevir) on January 1 this year and a usually quiet April - "April 2016 was an anomaly," he said.
He suspects the listing of Epclusa will bring "a bit of a spike" in treatment numbers and he sees Australia's strong primary care landscape as likely to keep treatment levels steady over time.
"Our primary care foundation should give us a relatively soft landing," he said. "In some countries the figures come screaming down after the first year of treatment."
He too sees increasing focus on prison populations as key to future success and feels that, though still comparatively modest, GP prescribing will help.
"I'm hoping for between 20,000 and 25,000 initiating treatment this year. If we're going to eradicate hep C by 2030, we're going to need 19,000 to 20,000 per year to get there," he added.
The one thing both Tyrrell and Dore agree on is the continuing need for campaigns of community awareness at both state and federal levels.
"I'm not complacent," says Dore. "It'll require a lot of hard work over the next several years but we have a better foundation than most other countries."
David Rowley
david.rowley@lushmedia.com.au
Posted 1 August 2017
PBS figures show that pre-rebate benefit earnings on the top three HCV drugs are rapidly falling as Gilead's new pan-genotypic option, Epclusa (sofosbuvir/velpatasvir) is PBS listed today, but experts give different reasons why.
Harvoni (ledipasvir/sofosbuvir) dropped from $194 million to $162 million from the first to second quarter this year while Sovaldi (sofosbuvir) declined from $240 million to $174 million and Daklinza (daclatasvir) $77 million to $65 million during the same period.
Harvoni was down by close to 61 per cent in the quarter to June this year as compared to the same period in 2016 while Sovaldi was down by 33.6 per cent and Daklinza by 32 per cent.
Hepatitis Australia CEO Helen Tyrrell doesn't see the decline as a result of 'warehousing', that is, patients being made to wait for the new, more convenient, pan-genotypic Epclusa.
"The warehouse is empty," she said. Although there was a massive number of people who were holding off prior to the first PBS listing in March last year, that base population of highly engaged patients from liver clinics - roughly 40,000 - has now been treated.
"We've got to go looking for them now," Tyrrell said.
These patients includes those for whom the disease is not foremost in their mind, including those who have injected drugs decades ago, are showing no serious symptoms and, combined with societal stigma, have their "head in the sand".
She said there was a need for multiple strategies including focusing on priority populations in prisons.
But the treatment drop-off, which she describes as the "waterfall effect" and which has often been cited as a major business headache for Gilead, comes as no surprise.
"We knew there would be this impact of a massive surge and then a drop-off," she said.
Professor Greg Dore, head of the Viral Hepatitis Research Program at the Kirby Institute, University of NSW, sees the fall as the result of a more nuanced combination of events, including the introduction of MSD's Zepatier (elbasvir/grazoprevir) on January 1 this year and a usually quiet April - "April 2016 was an anomaly," he said.
He suspects the listing of Epclusa will bring "a bit of a spike" in treatment numbers and he sees Australia's strong primary care landscape as likely to keep treatment levels steady over time.
"Our primary care foundation should give us a relatively soft landing," he said. "In some countries the figures come screaming down after the first year of treatment."
He too sees increasing focus on prison populations as key to future success and feels that, though still comparatively modest, GP prescribing will help.
"I'm hoping for between 20,000 and 25,000 initiating treatment this year. If we're going to eradicate hep C by 2030, we're going to need 19,000 to 20,000 per year to get there," he added.
The one thing both Tyrrell and Dore agree on is the continuing need for campaigns of community awareness at both state and federal levels.
"I'm not complacent," says Dore. "It'll require a lot of hard work over the next several years but we have a better foundation than most other countries."
David Rowley
david.rowley@lushmedia.com.au
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