A National Post article reported on a new drug, Harvoni, intended for the treatment of Hepatitis C, and its additional downstream medical benefits. The article argues that pharmaceutical companies do not receive the proportional value of their medicines when overall savings to the health care system are considered.
Harvoni is a genotype 1 Hepatitis C medication with a cure rate of 94 to 99 percent of cases. Hepatitis C causes inflammation in the liver and around 50 percent of Hep C cases become chronic, increasing the chance of incurring significant damage to the liver. One of the most common reasons for a liver transplant historically has been because of liver damage from chronic Hep C. However, there has been a huge shift in those numbers, from 44.5 percent of all liver transplants in 2010 to only 18.7 percent in 2019. One study attributes this decrease to highly effective antiviral medication, as well as increased screening.
Some research also suggests that because of the effectiveness of DAA (direct-acting antiviral) medications such as Harvoni, waitlists for liver transplants caused by a variety of conditions are being significantly shortened as surgeons can transplant a Hep C infected liver into someone who does not have the infection and cure them of the disease post-transplant. So, in addition to fewer people needing liver transplants from chronic Hep C, overall wait times are further reduced as infected liver transplants do not need to be restricted to those who already happen to have the disease.
The effectiveness of Hep C medications has caused great downstream medical benefits for patients and healthcare systems around the world.
However, the article seems to suggest that Harvoni is a breakthrough innovation coming from the labs of the pharmaceutical company Gilead. Harvoni was not the first DAA to be put on the market. A medication by Bristol–Myers Squibb was the first to be approved in the world in Japan with a cure rate of 91 percent. Although drugs like Harvoni have made improvements in their effectiveness, it was not the first and it is not the only medicine available to cure Hep C. The first-generation DAAs that were made in 2011, Telaprevir and Boceprevir, provided improvement in treatment but with low cure rates and challenging side effects.
One issue is that medicines build on past knowledge and innovation, making it difficult to attribute the benefits of a certain medication to just the producers of that drug. Harvoni itself is not the sole product of the pharmaceutical company Gilead. Harvoni is a combination medicine of two existing medicines Ledipasvir and Sofosbuvir. Sofosbuvir was developed by a scientist named Michael Sofia at a development company called Pharmasset. It wasn’t until 2013 that the company was bought by Gilead Sciences. In addition, Sofia could not have developed that medication without the groundwork science on the Hep C virus done in the 1990s by two scientists who conducted their research at public universities.
If the argument is being made that pharmaceutical companies’ medications are not high enough to appropriately capture the overall value of their medicines, exactly what proportion of value they have contributed to the medicinal technology should be demonstrated. This also comes at a time when high-cost drugs are putting enormous strain on global healthcare systems.