How treatment of hepatitis has evolved over the years

Hepatitis is a significant health problem in India. Let’s understand how the treatment for hepatitis has been revolutionised over the last several years

hepatitis

Last year, Indian researchers at the Sanjay Gandhi Postgraduate Institute of Medical Sciences in Lucknow announced that they had succeeded in developing a cost-effective treatment for hepatitis C, a blood-borne viral infection that kills by damaging the liver. The media labelled the development as having ‘far-reaching implications’.

Why was it hailed so? It was mainly because of two reasons: the size of the hepatitis C-afflicted population in India, and the high cost of treatment. Let us look at the first; according to the World Health Organization (WHO), six to 12 million people in India are chronically infected with the disease. It is more in the case of hepatitis B – 40 million. 

Note: There are five types of hepatitis viruses: A, B, C, D, and E. Each comes from a different source, and presents different symptoms. Viruses B, C, and D are chronic, while A and E are short-term though acute.

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What is even more alarming, says WHO, is the fact that a staggering 95% of those infected with chronic hepatitis are unaware of their condition, and as a result, succumb to liver cirrhosis and liver cancer. In India, viral hepatitis is now recognised as a serious public health problem. 

One should also note that the WHO has said that though directly acting antiviral (DAA) drugs can cure up to 95% of hepatitis C patients, currently there is no vaccine for the disease, though research (like the one in Lucknow) is on. Therefore, it can place a huge social and economic burden on the affected individual, family, as well as the health system.

An expensive proposition 

Alongside, treatment can be prohibitively expensive – even in the US, where, according to one estimate, five of the top ten most expensive drugs are for hepatitis C. So much so that private insurance companies and even public payers like Medicaid and Medicare are known to refuse paying for the treatment. As a result, many American patients seek treatment in India, where cheaper generic drugs and more affordable treatment procedures have been developed. 

However, what is ‘cheaper’ for an American may not be easily affordable for the average middle-class Indian; as against the $294,000 charged in the US for the full HCV treatment, the generic India-made DAA drugs cost Rs 19,000 for a month’s supply – which is by no means inexpensive for poor or middle-class Indians, especially if they have no health insurance. 

The drugs developed at the Lucknow facility is expected to be up to 45% cheaper – that is, by up to Rs 8500. But there is a catch: to avail of this cheaper treatment, the patient has to be admitted at this institute. 

For hepatitis B – a life-threatening viral infection spread through infected blood or body secretion – the cost of drugs and vaccines can start from as low as Rs 100 and go up to Rs 4000, depending on brand and type. The entire course will depend on the treatment duration and the dosage the doctor prescribes, as well as the city the patient is in. 

Add to it the tests. Broadly speaking, In India, the cost for hepatitis B HIV treatment can range from Rs 1500- 4000 per month, and about Rs 18,000- 48,000 over the course of a year. As for hepatitis C, even generic medicines can cost up to Rs 67,000 for the entire course of treatment. 

Evolution of treatment

As already noted, hepatitis C is a viral disease that can cause fatal liver cancer, buts its treatment has always proved difficult. Today’s hepatitis C therapies differ radically from what was available when the first treatment was discovered in 1989. Earlier, physicians resorted to a long list of pills and injections that had umpteen side effects and often caused more damage to the liver than good. Some of these side effects were headache, nausea, vomiting, fatigue, low blood cell count, gastroenteritis, muscle cramps, and joint pains; the liver too would be damaged.

In the early 1990s, doctors prescribed a series of protein-based (interferon) injections, a generic drug to mobilise the body’s natural immune system to fight the disease. However, the success rate was only 6%-16%, which meant that a combination of treatments was needed. Also, there were side effects such as hair loss, severe depression, gum disease, nausea or vomiting, liver damage, and even suicidal thoughts. 

Response rate increased to 39% by the turn of the century and 68%-84% by 2011, but side effects included exfoliative dermatitis, lowered white blood cell count, rectal pain, and birth defects. By 2015, clinical trials showed 97% cure rate for people with hepatitis C genotype 1. 

A major breakthrough came in 2016 when sofosbuvir/velpatasvir‎ (Epclusa) was developed as a drug therapy to treat all hepatitis C genotypes in tablet form for the first time. The cure rate was a high 98% for patients without cirrhosis and 86% for those with it, while the side effects – headache and fatigue – were considered low.

In August 2017, glecaprevir/pibrentasvir (Mavyret) was approved as a treatment for adults with chronic hepatitis C genotypes 1 through 6, The treatment duration, which can be as little as eight weeks, showed results of 92-100% in early trials with no evidence of post-treatment infections.

Insurance cover

There is an array of affordable and quality insurance options for you and your family, but if you are one of those with an adverse health condition, you probably know that trying to get treated can be like running into a wall. Often people may not know they have a condition until they apply for a health plan, but it is not entirely impossible for them to get insurance coverage.

Such people include those with hepatitis; they are not always denied health plans, and in some cases, individuals who have made a full recovery have obtained standard policies paying average premium rates. Please note that if you have health insurance with the critical illness rider – which covers hepatitis – you could qualify for the predetermined payout stated in the plan if the condition was discovered later. 

However, the actual underwriting on the application for such coverage may hinge on the severity of the condition, and the length of time the applicant has had the disease. Also, as medicines for hepatitis are expensive, you may have to fulfil certain conditions. Moreover, premium and coverage will vary from case to case and depend on the type of hepatitis, treatment history, recovery condition, and the applicant’s medical history. 

So if you are a smoker, you may have to pay twice as much as a non-smoker for the same coverage. In other words, it is advised to get all the details of the plan cover and talk to one’s insurance agent when you are buying a policy.

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