Segment 5 - The Role of the Primary Care Physician and Hepatologist in Treatment Regimens

The panelists continue to debate whether hepatitis C virus (HCV) treatment should be administered by primary care physicians (PCPs) or hepatologists.

Dr Miller addresses the PCP approach to management: “I think that the truth is probably somewhere in between. I actually think for a hepatologist to do the staging and decide who’s appropriate for therapy is still going to be crucial,” he says. “I think as the newer products come on the marketplace and if they continue to show the relatively few side effect as they are, then you will be able to send [patients] back to the PCP to monitor their course of therapy.”

Dr Miller adds that currently, a plan sponsor spends about $10 per patient per year on the treatment of HCV. So if the average person spends about $1000 per year on drugs, $10 is devoted to HCV. By 2015, that cost will grow to $45 per patient per year for HCV—quite a dramatic increase.

He adds that for healthcare systems or big employers, their ability to cover that increase is “really going to challenge them.” Providers and payers can ensure money is not wasted by treating patients appropriately. The PCP, however, may face challenges with the complexity of regimens, so a hepatologist will be crucial early on.

The panelists go on to discuss the economic implications of cost sharing, side effect profiles of treatments, and efficacy of different therapies. The discussion concludes that patients should not be put on higher-risk, less-efficacious drugs like interferon simply for reasons associated with cost.