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Barriers and Key Issues
“I was reluctant at first but realized that we can do a better job because of what we already know about adherence and supporting people. HIV providers are already accustomed to working in advance of peer reviewed data and using treatment with low efficacy and lots of toxicities. This doesn’t have to be cutting-edge; you, too, can have a coinfection clinic.”147 —Kathleen Clanon, MD |
HCV Treatment: Estimating the Cost
Providers planning to offer care and treatment to coinfected patients must adequately plan to meet client needs. Part of this planning means estimating the cost of care and establishing mechanisms for paying for it. HIV service providers are operating in a world with growing health care costs and growing HIV prevalence among the poor and uninsured. Many HIV/HCV-coinfected patients are also poor and underserved, and most rely on public support to meet care and treatment needs. Thus, providers must ask, Will we be overwhelmed by the high costs of providing HCV care and treatment to coinfected patients?
By any standard, HIV diagnostics and treatment are expensive, as are the interventions for management of side effects, and providers must plan accordingly. Most Medicaid programs include medications for HCV treatment in their formularies, and 17 State AIDS Drug Assistance Programs (ADAPs) cover pegylated interferon and ribavirin (see Access to HCV Treatment and ADAPs).
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The cost of a 30-day supply of ribavirin (based on a dose of 800 mg/day) ranges from $500 to $1,100, depending on the manufacturer.*
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The cost of four once-weekly injections of pegylated interferon also varies by product and ranges from $1,300 to $1,500 per month.
But as discussed in the preceding pages, most people living with HCV do not receive treatment. It is hoped that improvements in access to high-quality, culturally competent care services will increase the number of people who do receive HCV treatment. But given the low utilization today of treatment—which is, by far, the most expensive element of care for coinfected patients—the cost of providing comprehensive HCV services will be less than prevalence data might suggest.