12 Years of Universal Access to Hepatitis C Treatment

Naveira, Marcelo Contardo Moscoso; Barbosa, Jarbas; Sereno, Leandro; Domanico, Andrea; Mesquita, Fábio; Souza, Laura Alves de

doi:10.1177/2325957414547739

Cited by 6 publications

(9 citation statements)

References 41 publications

(67 reference statements)

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“…In Brazil, Ministry of Health provides access to HCV treatment since 2002, following a National Guideline applied only to the Brazilian public healthcare system that includes interferon or pegylated interferon, ribavirin, sofosbuvir, simeprevir, daclatasvir and ombitasvir/veruprevir/ritonavir plus dasabuvir (11)(12)(13)(14) . Patients receiving those therapies through government funding need to be attending a public medical facility specialized in HCV treatment.…”

Section: Introductionmentioning

confidence: 99%

Hepatitis C in the Brazilian Public Health Care System: Burden of Disease

Castelo

Mello

Teixeira

et al. 2018

Arq. Gastroenterol.

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BACKGROUND: Infection by hepatitis C virus is one of the leading causes of chronic hepatitis C and cause severe burden for patients, families and the health care system. OBJECTIVE: The aims of this research were to assess the severity of liver fibrosis, comorbidities and complications of hepatitis C virus; to examine health-related quality of life (HRQoL), productivity loss and resource use and costs in a sample of Brazilian chronic hepatitis C, genotype 1, patients. METHODS: This was a cross-sectional multicenter study performed in genotype-1 chronic hepatitis C patients to assess disease burden in the Brazilian public health care system between November 2014 and March 2015. Patients were submitted to a liver transient elastography (FibroScan) to assess liver fibrosis and answered an interview composed by a questionnaire specifically developed for the study and three standardized questionnaires: EQ-5D-3L, HCV-PRO and WPAI:HepC. RESULTS: There were 313 subjects enrolled, with predominance of women (50.8%), caucasian/white (55.9%) and employed individuals (39.9%). Mean age was 56 (SD=10.4) years old. Moreover, 42.8% of patients who underwent FibroScan were cirrhotic; the most frequent comorbidity was cardiovascular disease (62.6%) and the most frequent complication was esophageal varices (54.5%). The results also showed that “pain and discomfort” was the most affected HRQoL dimension (55.0% of patients reported some problems) and that the mean HCV-PRO overall score was 69.1 (SD=24.2). Regarding productivity loss, the most affected WPAI:HepC component was daily activity (23.5%) and among employed patients, presenteeism was more frequent than absenteeism (18.5% vs 6.5%). The direct medical costs in this chronic hepatitis C sample was 12,305.72USD per patient in the 2 years study period; drug treatment costs represented 95.9% of this total. CONCLUSION: This study showed that most patients are cirrhotic, present high prevalence of cardiometabolic diseases and esophageal varices, reduced HRQoL mainly in terms of pain/discomfort, and work productivity impairment, especially presenteeism. Additionally, we demonstrated that hepatitis C virus imposes an economic burden on Brazilian Health Care System and that most of this cost is due to drug treatment.

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Section: Introductionmentioning

confidence: 99%

Hepatitis C in the Brazilian Public Health Care System: Burden of Disease

Castelo

Mello

Teixeira

et al. 2018

Arq. Gastroenterol.

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“…Based on the need to refine and to improve the history of committing to the provision of universal access to hepatitis C treatment in Brazil during the last 15 years [4], this remarkable process of evidence-informed policy making–which involved many different actors–changed the Brazilian Clinical Guidelines for Hepatitis C in 2015. Brazil revolutionized the response to hepatitis C epidemic motivated by the nation’s engagement in the Sustainable Development Goals.…”

Section: Discussionmentioning

confidence: 99%

“…There were no means of diagnosing HCV infection until early 90’s, when tests finally became available and routinely performed in blood banks [4]. Such restriction of technology in diagnosis was also common to therapeutics, which until recently was mostly acknowledged by poor treatment adherence and efficacy and high rates of adverse events.…”

Section: Introductionmentioning

confidence: 99%

The Brazilian comprehensive response to hepatitis C: from strategic thinking to access to interferon-free therapy

et al. 2016

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BackgroundHepatitis C affects over 185 million people around the world. This silent disease is responsible for up to 700,000 deaths per year. Despite the scientific revolution in diagnosis and treatment, hepatitis C control remains a huge challenge due to the cost of effective medications.In response to the global outcry of hepatitis epidemic and the need to improve the nation’s public health response, the Ministry of Health of Brazil revolutionized hepatitis C treatment by incorporating highly effective drugs that can be accessed through sustainable and universal means.DiscussionThis paper describes the unique process of implementing evidence-informed policy to respond to hepatitis C epidemic through the update of hepatitis C treatment in Brazil based on the estimate of disease prevalence, current international guidelines, and the cost-effectiveness impact in the Brazilian Unified Health System. Through a debate of an experience report, the authors underlie the strategic plan implemented according to the situation analysis that emphasized the need to improve its current response over a relatively short-term period. The comprehensive response is detailed comprising three main objectives: improve treatment outcomes by evaluating and incorporating new and effective medications at a sustainable price; elaborate on clinical guidelines to treat hepatitis C patients; and develop awareness and diagnosis campaigns targeted at the population of interest. In this scenario, Brazil was able to obtain an unprecedented discount for a high-medium income country; provided treatment to more than 7000 individuals in the last 2 months of 2015; and expects to treat 38,000 new patients in 2016.SummaryThe remarkable process applied in Brazil was developed according to epidemiological data and scientific evidence, and it was motivated by the engagement of the country in the Sustainable Development Goals, which may inspire other developing countries to identify ways to achieve these goals by 2030.

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“…The northern region of the country is the location of the Amazon forest, as well as built-up areas, traditional indigenous populations, and a low population density; providing access to adequate medical care in these areas is diffi cult, and preventative measures are not very well accepted. Most urbanized areas, however, have better access to health programs and adoption of preventative measures; such areas are concentrated in the South and Southeast regions (23) , and these factors may contribute to the higher rates of hepatitis C recorded in urbanized areas.…”

Section: Methodsmentioning

confidence: 99%

Incidence of hepatitis C in Brazil

Hanus

Ceretta

Simões

et al. 2015

Rev. Soc. Bras. Med. Trop.

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Introduction: Hepatitis C is a public health problem of global dimensions, affecting approximately 200 million people worldwide. The main objective of this study was to estimate the incidence rate of hepatitis C in Brazil during the period between 2001 and 2012. Methods: An epidemiological, temporal, and descriptive study was performed using data from the Information System for Reportable Diseases. Results: Between 2001 and 2012, a total of 151,056 hepatitis C cases were recorded, accounting for 30.3% of all hepatitis notifi cations in Brazil. The average gross coeffi cient for the analysis period was 6.7 new cases per 100,000 inhabitants. The regions with the highest rates were the Southeast region (8.7 new cases/100,000 inhabitants) and the South (13.9 new cases/100,000 inhabitants). There was a predominance of men with respect to the incidence rate (8.0 new cases/100,000 inhabitants) compared to women (5.5 new cases/100,000 inhabitants). Injection drug use was the most common source of infection, and members of the white race, residents of urban areas, and those aged 60 to 64 years had the highest incidences. Conclusions: Over the last 10 years, the incidence of hepatitis C in Brazil has increased, mainly in the South and Southeast. The adoption of fast, accurate diagnostic methods, together with epidemiological awareness, can facilitate early intervention measures for adequate control of the disease.

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12 Years of Universal Access to Hepatitis C Treatment

Cited by 6 publications

References 41 publications

Hepatitis C in the Brazilian Public Health Care System: Burden of Disease

Hepatitis C in the Brazilian Public Health Care System: Burden of Disease

The Brazilian comprehensive response to hepatitis C: from strategic thinking to access to interferon-free therapy

Incidence of hepatitis C in Brazil

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