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Expert Interview

Slingshot members are talking to an expert! The topic is:

Understanding the impact of Merck's ZEPATIER on the HCV market as it now competes with HARVONI and Viekira Pak

Ticker(s): GILD, MRK, ABBV

Who's the expert?

Name: Dr Bruce Bacon - MD

Institution: Saint Louis University School of Medicine

  • Professor of Internal Medicine & Gastroenterology and Co-director of the Saint Louis University Liver Center — a Center of Excellence in research and treatment of liver diseases.
  • Areas of expertise include hepatitis C and B, cirrhosis, liver transplantation, and hemochromatosis; Treats a high volume of hepatitis patients and currently has active clinical research programs in the area of viral hepatitis. 
  • Chair of the GI Board and the Transplant Hepatology Board for the American Board of Internal Medicine and President of the American Association for the Study of Liver Diseases.

Interview Questions

Please give use your background in treating HCV and how many patients you have treated with Harvoni, sovaldi, Viekira Pak, and Incivek?

Added By: joemac84

How do you anticipate the approval of Zepatier effecting your usage of Harvoni? Please note that Merck has disclosed the intended price of $54,000 for a 12 week treatment.

Added By: joemac84

Price aside, how do you compare the safety and efficacy of the 3 "new" drugs on the market now? Harvoni, Viekira Pak and Zepatier.

Added By: joemac84

Can you give your thoughts on the issue of undiagnosed chronic Hep C.  How big is this population? What are the health implications of not getting treated until symptoms appear?  Should Hep C testing be done periodically as part of a routine physical exam, instead of limited to those 'at risk'? If caught early (before symptoms), would it be treated with the new drugs (Harvoni, Zepatier, etc)?  Would early treatment/cure ultimately save the healthcare system money or would treatment without symptoms be considered over-treatement?

Added By: william gerber

Zepatier requires patients be tested for NS5A polymorphisms if they are Genotype 1a. How difficult, expensive and time consuming is it for the average treating physician to do this test? 

Added By: joemac84

In patients that test positive for GT-1a and NS5A polymorphisms, do you anticipate many doctors will still try and make Zepatier work? (ie. add 4 weeks of treatment and ribavirin) or do you think that will be enough to get Harvoni prescribed?

Added By: joemac84

Is there a reason one genotype would be under treated or under diagnosed at this point in the HCV curing cycle that is occurring more broadly?  How big are these populations?

Added By: joemac84

On a recent earnings call an executive from Gilead made this point:
"other than the costs of drug, you should also consider of course the cost of treatment. There is a genotype required for genotype 1a, the resistance test will cost about $700, and incurs some time delay. There's tests for ALTs at eight weeks and at 12 weeks if you have to dose for 16 weeks. And also, it's possible that - well, a fairly significant number of the genotype 1a patients, and you know those are 50% in U.S., they will require 16 weeks with ribavirin. So that's not - it's more than - it increases the treatment cost proportionally compared to 12 weeks or eight weeks in our case with Harvoni."

Do you think this is accurate and something that will continue to impress payors and physicians or is it overly optimistic/slanted towards Harvoni?

Added By: joemac84

Do you see a group of patients that it makes sense to prescribe Viekira Pak to still? How big is that group of patients.  If the current type of patient starting on Viekira Pak patients no longer does is that going to be to Zepatier?

Added By: joemac84

Is there any warehousing going on again (like before Incivik and Harvoni), but this time due to price (not a better drug coming)? What I mean is: Are there a significant number of patients saying let's wait a few years and see if this gets cheaper through more entrants, negotiations, whatever, before treating.  

Do you think that is "ok" to do if any are?

Added By: joemac84

Are You Interested In These Questions?

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