Managed Care Considerations in the Management of Hepatitis C Virus Infection

Chronic hepatitis C virus (HCV) infection has been dubbed the “silent epidemic” because the infection remains quiescent for years, even decades, before clinically significant symptoms appear. The majority of Americans currently living with chronic HCV infection were infected before testing for the virus in blood products began in the early 1990s; therefore, an “age wave” of HCV infection complications is expected to occur as these individuals enter their 50s and 60s. Treating HCV infection and liver diseases in an elderly population will bring challenges specific to this population. Also, the current gold standard therapy for HCV infection, combination pegylated interferon and ribavirin, results in lower rates of sustained virologic response (SVR) in elderly populations, with higher risks of cytopenia and anemia. The age-related increase in HCV-related morbidity and mortality is expected to result in dramatically higher medical costs. Several comorbidities are associated with HCV infection, including human immunodeficiency virus infection, which can impact the efficacy of treatment, outcomes, and medical costs. Although costeffective and moderately efficacious therapies exist to manage chronic HCV infection, none are ideal in terms of efficacy and safety, and all have significant barriers to use. The introduction of newer therapies, including the protease inhibitors, has the potential to shift the natural history of chronic HCV infection by triggering much higher SVR rates in treatment-naïve patients, nonresponders to previous therapies, and those who have relapsed follow-