Probably the biggest ethical dilemma now confronting the health care world involves two expensive new drugs to treat hepatitis C. The issue boils down to a tradeoff between efficacy and cost. One drug, Sovaldi, has a 90 percent cure rate for newly infected patients – much better than previously available treatments for hepatitis C. It also costs $84,000 for a 12-week treatment – basically $1,000 per day. The second drug, Olysio, is about $66,000 for a 12-week treatment, but is approved for fewer types of patients. Some patients face even longer treatment periods – and higher costs. Georgia Medicaid covers the drugs, though with some restrictions, for its 1.6 million beneficiaries. In March, Georgia’s Drug Utilization Review Board recommended that Medicaid add Sovaldi and Olysio as “non-preferred,” and needing a state approval in each case. In April, 107 Medicaid patients were taking Sovaldi, at a cost of roughly $3 million per month to the program, though the state will receive a rebate that will lower that cost. Still, physicians say the use of these two drugs is a breakthrough. “It really transformed treatment for hepatitis C,’’ Dr. Anjana Pillai, an Emory transplant hepatologist, told GHN on Tuesday.