The last few years have been marked by public outcry over the costs of novel prescription drugs, such as the hepatitis C medication sofosbuvir (brand name Sovaldi), which are highly efficacious but extremely expensive. On the one hand, sofosbuvir produces cure rates of  >90%, a figure that seemed unthinkable a few decades ago. On the […]

The last few years have been marked by public outcry over the costs of novel prescription drugs, such as the hepatitis C medication sofosbuvir (brand name Sovaldi), which are highly efficacious but extremely expensive.
On the one hand, sofosbuvir produces cure rates of  >90%, a figure that seemed unthinkable a few decades ago. On the other, it is priced at approximately $1000 per pill ($60,000–$90,000 for a treatment course), making it unaffordable for many patients. This price tag has spurred physician and advocacy groups to call for price lowering so that more patients can benefit. In turn, the drug manufacturer has defended its price point by giving sofosbuvir’s high efficacy. Fundamentally, part of the disagreement is one of value. What is an appropriate amount to pay for a medication with undisputable benefit?
A pair of studies published in Annals of Internal Medicine shed light on this issue through cost-effectiveness analyses of novel HCV regimens. In the first study, researchers showed that from a societal perspective, sofosbuvir-based regimens are more cost-effective than older treatment regimens for patients with genotype 1 HCV and potentially for patients with genotype 3 HCV.  Similarly, in the second study, investigators demonstrated that sofosbuvir-based regimens can be cost-effective for most patients, from the perspective of a third-party payer.
These analyses are important for quantifying the potential costs and benefits of treating HCV patients with sofosbuvir-based regimens. However, it would be incorrect for clinicians to simply conclude that we should provide unqualified support for novel treatments because they are deemed cost-effective. Instead, physicians should recognize a few critical features of these analyses:
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