Hepatitis C: Summary of Recommendations
An estimated 4 million people in the United States are infected with hepatitis C, a virus that attacks the liver and can lead to liver damage and death. Medications called pegylated interferons can help eliminate the virus from the body, but they are very expensive, costing between $15,000 and $30,000 for a course of treatment.
Our Best Buy Drugs report analyzed the evidence for the two available pegylated interferons—peginterferon alfa-2b (PegIntron) and peginterferon alfa-2a (Pegasys)—and found that while neither has been shown to be clearly more effective or safe, there is a considerable difference in price. PegIntron could save you hundreds to thousands of dollars over Pegasys, depending on the dose and length of treatment.
The hepatitis C virus is transmitted by exposure to blood and other bodily fluids from an infected person, most commonly by sharing needles used for injecting illicit drugs, such as heroin. It can also be transmitted sexually, by contaminated needles used for tattoos and piercings, mother to child during birth, and by accidental needlesticks occurring in healthcare workers.
Some people clear the virus on their own, but most people (75 to 85 percent) will not. Hepatitis C may not cause any noticeable symptoms at first, but over time, if left untreated, it can cause liver damage, leading to liver failure and even death. The only way to know for certain you are infected is a blood test.
The pegylated interferons are usually used in combination with another drug called ribavirin. This combination therapy is the treatment of choice because it is the most effective, eliminating hepatitis C from the blood for at least 6 months ("treatment success") in 55 to 60 percent of people. Your likelihood of treatment success may be higher or lower depending on the strain of virus you’re infected with. But there is not enough long-term data to know if treatment decreases the risk of important future complications from chronic hepatitis C infection, such as liver cirrhosis, liver cancer, need for liver transplantation or death.
Neither PegIntron nor Pegasys is available as a generic, and neither has been shown to be clearly more effective or safer than the other, so our choice comes down to cost. Taking all the evidence into consideration, for people with chronic hepatitis C infection who meet the criteria for combination therapy, we selected as our Best Buy pick:
- PegIntron + generic ribavirin tablets
PegIntron could save you $72 to $820 per month over Pegasys, depending on the formulation you need. Most people will be treated for at least 24 weeks (about 5 and a half months), and possibly for 48 weeks (a little over 11 months). So the average savings of PegIntron could be significant, ranging from $403 to $4,592 over 24 weeks to $806 to $9,184 over 48 weeks.
Each pegylated interferon is only approved to be used in combination with a specific branded ribavirin (Copegus with Pegasys and Rebetol with PegIntron). However, generic ribavirin tablets may be your best bet because they are significantly less expensive. A month's supply of generic ribavirin will save you $600 to $1,050 per month over Rebetol and $1,320 to $2,310 per month over Copegus, depending on dose.
You should know that combination therapy can cause a wide range of side effects, some serious. The most common side effects include flu-like symptoms, such as muscle aches, fever, and fatigue, depression, diarrhea, nausea, and rashes or other skin-related problems. Life-threatening or fatal problems are rare but include suicide, relapse of drug abuse or overdose, and liver failure. If you have a history of serious mental disorders, including major depression, bipolar disorder, or psychosis, you may not be able to take these medicines. Most doctors will not treat you if you drink alcohol or use illicit drugs.
Ribavirin can cause birth defects, so you should not take the drug if you're a pregnant woman or planning to get pregnant or breast-feeding, or if you're a man whose partner is trying to get pregnant. And if you are treated with ribavirin, make sure to use reliable birth control measures as long as you take the drug, and for six months afterward.
This report was released in June 2010.