Hepatitis C could be eliminated in Canada, but drug prices, screening barriers stand in the way

Marsha Lecour was just four years old when she contracted hepatitis C. She was born with a heart condition that required open heart surgery.

"During the surgery, a blood transfusion was administered. And the blood transfusion contained what they call'tainted blood,'" said Lecour, now 65 and living in Toronto.

It wasn't until decades later, when she was in her 30s, that a blood testrevealed shehad a virus waging war on her liver.

"The doctor said that I would probably require a liver transplant," she said. "I'd never even heard of hepatitis, and never mind a liver transplant."

Hepatitis C is primarilyspread through blood-to-blood contact, including unsafe drug injections, improperly sterilized piercing,tattoo or medicalequipment,and in cases like Lecour's, contaminated blood. People infected with the virus often don't know they have it. Some don't find out until they're faced withadvanced liver disease, including cirrhosis or liver cancer.

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Lecourlived with the disease for more than 50 years, trying to minimize the damage to her liver through diet, not drinking alcohol and meditation. Finally, in 2012,her liver specialist at Toronto's University Health Network started her on a "gruelling" medication combination that would cure the disease.

"Some people say it's like chemo in some ways in terms of the side-effects," Lecour said. "I lost some of my hair, I lost weight, I was depressed.... I was really a basket case."

That approvedtreatment took almost a year, and withalmost no energy, Lecourcouldn't work at her job as high school teacher.

But in the end, Lecourwas cured of hepatitis C and says her life is "great," free of the fatigue that the virus can bring, and hopeful the cirrhosis it caused is improving. Had she not had an "excellent" work benefit plan that covered the high costs of the drugs, she doesn't know what she would have done.

The same issue is faced bymany of the 70 millionpatients infected with hepatitis C worldwide and governments that fund prescription drugs, said Andrew Hill, an infectious disease and pharmacology expert at the University of Liverpool in the U.K.

"People are not getting the treatments they need," Hill said. "Governments are saying, 'This is too expensive,' and they're not treating everybody."

In a presentation to the World Hepatitis Summit in Sao Pauloon Thursday, Hill said 90 per cent of hepatitis C patients can now be cured in 12 weeks, at a cost of about $50 US per patient. In addition, the side-effects are minimal, so most patients wouldn't have to endure what Lecourdid.

That cure is a combination of antiretroviral drugs called Sofosbuvir and Daclatasvir. According to Hill's research, the price charged by pharmaceutical manufacturers in Canada for 12-week course of treatment is about $68,000 US. In the U.S., the price has skyrocketed to almost $143,000, his research says.

CBCNews made callstoGileadSciences, manufacturer ofSofosbuvir, and to BristolMyersSquibb, manufacturer ofDaclatasvir, to inquire about their pricing, but they werenot returned as of Friday morning.

The enormous difference between what the drugs cost to make and the profits garnered by pharmaceutical companies not only makes the cure for hepatitis C too expensive for patients it could also discouragegovernment health agencies from conducting widespread screening for the virus, Hill said.

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"There are some governments that are too worried about producing a massive bill, that if they tested large numbers of people, they then haveto spend tens of thousands [of] dollars on curingeach one of those people. And they just don't have that kind of money."

Many countries including Canada have committed to a global goal of eliminating hepatitis C by 2030. But new data released at the summit in Brazil shows that only nine countries are on track to meet that objective and Canada is not among them.

Some affected populations lack 'political voice'

Dr. Jordan Feld, a hepatologistat theToronto Centre for Liver Disease at the University Health Network and the specialist who treated Lecour, said hepatitis C is "a huge public health problem right here in Canada" and it's "disappointing" to hear that the virus may not be eliminated in the next 13 years a goal he believes is achievable.

"We now have the tools. We can diagnose thissimply, we have treatment that works in almost everybody," he said. "We could eliminate hepatitis C fromCanada."

Although theprice of the drugs to cure hepatitis C aretoo high, Feld said, it has "come down dramatically"in Canada from what they were.

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For Feld, the larger barrier to curing the estimated 250,000 people infected withthe virus in this country is the absenceof a "targeted, well-structured nationalplan" to actually reach those patients.

"Unfortunately, hepatitis C is highly overrepresented in marginalized populations and some of these people just don't have as strong a political voice," Feld said.

"To be perfectly honest, if this was an infection that affected an upper middle class, wealthypopulation, I don't think we would be having this discussion about not addressing hepatitis C," he said.

But no matter what their background, Feldadvocates broadening screening in Canada to everyoneborn between 1945 and 1975 a practice recommended by the Canadian Liver Foundationbut rejected by the Canadian Task Force on Preventive Health Care.

Feld argues that a variety of factors, includingblood transfusions that were unsafe, past drug experimentation and medical practices that involved contamination years ago,can all put that age group at risk for hepatitis C.