Hepatitis C: Treatment Options and Costs Explained - Gastroenterology and Hepatology

Hepatitis C

Hello Doctor: My brother had hepatitis B when he was a student, with liver enzyme levels close to 100.
A few months ago, while serving in the military, he underwent tests at the Tri-Service General Hospital in Taipei and found that he no longer has hepatitis B but now has hepatitis C.
His enzyme levels have decreased a bit, but how could he have developed hepatitis C? Could it be that he has both hepatitis B and C? What is the current success rate of interferon treatment for hepatitis C? If the treatment is ineffective, what are the alternative treatment options? He is currently in the military; if he receives interferon treatment at Tri-Service General Hospital, will it be out-of-pocket? Approximately how much would it cost? If he has both hepatitis B and C, what would be the best treatment approach? Thank you, Doctor!

dreamsky, 20~29 year old female. Ask Date: 2003/05/22

Dr. Yang Peizhen reply Gastroenterology and Hepatology

Hello! Your brother may be a carrier of Hepatitis B, and previously, due to the lack of testing for Hepatitis C, it was mistakenly believed to be only Hepatitis B; or Hepatitis C could be a new infection (which is less likely).
The most important issue is how to determine which type of hepatitis it is, as the treatment methods and effectiveness differ significantly.
The most accurate approach is to directly measure the concentrations of Hepatitis B virus (HBV-DNA) and Hepatitis C virus (HCV-RNA) in the blood.
Even in cases of co-infection with Hepatitis B and C, typically only one type of hepatitis will manifest.
For the treatment of Hepatitis C, if only interferon is used, the success rate is about 20%.
However, when combined with an oral antiviral medication, ribavirin, the success rate can increase to 40-50% (the success rate varies depending on the subtype of Hepatitis C; types II and III have much better outcomes than type I).
Generally, treatment should last at least six months, so it is essential to first determine the subtype of the virus.
If it is type I, it is best to choose long-acting interferon (one injection per week, costing between 6000-8000 NTD per injection).
If it is type II or III, short-acting interferon can be selected (three injections per week, costing about 1000-1200 NTD per injection).
The dosage of ribavirin is determined by body weight, typically 4-6 capsules per day, with the price still uncertain (as it has just been released), estimated to be in the hundreds of NTD, making it an expensive medication.
If short-acting interferon is ineffective, long-acting interferon can be considered.
If long-acting interferon is still ineffective, one may consider increasing the dosage or extending the treatment duration.
If it remains ineffective, the only option is to wait for new medications to become available.
Currently, both interferon and ribavirin are out-of-pocket expenses; however, some hospitals may provide certain medications for free as part of ongoing clinical trials, so it is advisable to inquire at major medical centers.
For treating Hepatitis B, there are two options: oral Lamivudine and interferon injections, both of which require out-of-pocket payment with an efficacy of about 50%.
Each has its own criteria for selection, and if needed, you can consult a hepatologist for detailed advice.
Typically, even in cases of co-infection with Hepatitis B and C, only one type will manifest.
If, unfortunately, both viruses are present, the only option is to treat both viruses with interferon and ribavirin together.
Best wishes for health from Dr.
Yang Pei-Chen, Department of Gastroenterology, Taoyuan Hospital, Ministry of Health and Welfare.

Reply Date: 2003/05/22

More Info

Hepatitis C is a significant public health concern, and understanding its treatment options and associated costs is crucial for patients and their families. Your brother's situation, transitioning from Hepatitis B to Hepatitis C, raises several important questions regarding the nature of these infections, treatment efficacy, and financial implications.

Firstly, it is essential to clarify how one can transition from Hepatitis B to Hepatitis C. Hepatitis B (HBV) and Hepatitis C (HCV) are caused by different viruses. It is possible that your brother was a carrier of Hepatitis B and was either misdiagnosed or that he has developed a new infection with Hepatitis C. In some cases, individuals can have co-infections with both viruses, but typically, one virus may dominate the clinical picture. The best way to confirm the current status is through specific blood tests that measure the viral load of both HBV and HCV.

Regarding treatment options for Hepatitis C, the landscape has changed significantly in recent years. Historically, interferon-based therapies were the standard treatment, but they came with considerable side effects and variable success rates. Today, direct-acting antiviral (DAA) medications are the primary treatment for Hepatitis C. These medications have revolutionized the treatment landscape, offering cure rates exceeding 95% for most genotypes of the virus with fewer side effects compared to older treatments.

If your brother is diagnosed with Hepatitis C, the treatment typically involves a regimen of DAAs taken orally for 8 to 12 weeks, depending on the specific medication and the genotype of the virus. The success rate of these treatments is quite high, often around 95% or more, which is a significant improvement over the older interferon-based therapies.

As for the costs associated with treatment, it can vary widely based on the specific medications prescribed and the healthcare system in place. In the United States, the cost of DAA therapy can range from $26,000 to $94,000 for a full course of treatment, depending on the specific drugs used and the duration of therapy. However, many insurance plans cover a significant portion of these costs, and there are also patient assistance programs available for those who qualify.

If your brother is currently serving in the military and receiving treatment at a military hospital, it is advisable to check with the medical facility regarding coverage and potential out-of-pocket expenses. Military healthcare often provides comprehensive coverage for necessary treatments, which may alleviate some of the financial burden.

In cases where treatment with DAAs is ineffective or if the patient has a more complex case involving both Hepatitis B and C, alternative treatment strategies may be necessary. This could involve a combination of antiviral therapies tailored to the specific viral infections present. It is crucial for your brother to work closely with a healthcare provider specializing in liver diseases to determine the best course of action based on his unique situation.

In summary, Hepatitis C treatment has advanced significantly, with high cure rates and more tolerable side effects. Understanding the nature of the infection, confirming the diagnosis through appropriate testing, and discussing treatment options with a healthcare provider are essential steps. Additionally, exploring financial assistance and insurance coverage can help manage the costs associated with treatment.

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