Targeted direct-acting antiviral treatment for chronic hepatitis C: A financial reality or an obstacle to elimination?

Hellard, Margaret; Pedrana, Alisa; Scott, Nick

doi:10.1016/j.jhep.2016.11.007

Cited by 6 publications

(8 citation statements)

References 11 publications

(14 reference statements)

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“…With Indigenous Australians constituting around 2% of the SA population [75], HCV notifications for Indigenous Australians were over six times that of non-Indigenous people. This is higher than previously reported in Australia [82, 106, 107], and may reflect geographical differences in risk behaviours [20]. This inequity may be explained by structural or social factors influencing position on the social gradient of health [38, 86, 121].…”

Section: Discussionmentioning

confidence: 69%

“…HCV treatments were recently transformed with Direct Acting Antiviral medications (DAAs) providing superior regimens, lower toxicity, and virus clearance in around 95% of cases [9, 11, 13–17]. Yet most countries do not offer affordable access to DAAs due to prohibitive expense [9, 18–20] and only around 7 % of people diagnosed with HCV globally have received treatment [2]. In response to issues with low treatment uptake, the World Health Organization (WHO) is urging action to ensure DAAs are affordable and accessible to people who need them; with the aim of eliminating viral hepatitis as a public health threat by the year 2030 [9, 21].…”

Section: Introductionmentioning

confidence: 99%

“…In Australia, HCV prevalence is estimated at around 1 % [3], with approximately 230,000 HCV cases, of whom 75% are diagnosed [12, 68]. Although DAAs remain largely inaccessible in most countries, affordable access has been available in Australia since March 2016 through Government subsidy [9, 18, 19, 69]. Furthermore, in 2016 prescribing regulations were reformed in Australia enabling the majority of patients with less complicated chronic HCV infections to be treated by general practitioners in the community.…”

Section: Introductionmentioning

confidence: 99%

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RETRACTED ARTICLE: The distribution and socioeconomic burden of Hepatitis C virus in South Australia: a cross-sectional study 2010–2016

Edmunds,

Miller,

Tsourtos

2019

BMC Public Health

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Background Hepatitis C virus infection (HCV) is a communicable disease of increasing global importance with 1.75 million new infections and 400,000 related deaths annually. Until recently, treatment options have had low uptake and most infected people remain untreated. New Direct Acting Antiviral medications can clear the virus in around 95% of cases, with few side-effects. These medications are restricted in most countries but freely accessible in Australia, yet most people still remain untreated. This study applies a cross-sectional research design to investigate the socio-spatial distribution of HCV in South Australia, to identify vulnerable populations, and examine epidemiological factors to potentially inform future targeted strategies for improved treatment uptake. Method HCV surveillance data were sourced from South Australia’s Communicable Diseases Control Branch and socio-economic population data from the Australian Bureau of Statistics from January 2010 to December 2016 inclusive. HCV cases were spatially mapped at postcode level. Multivariate logistic regression identified independent predictors of demographic risks for HCV notification and notification source. Results HCV notifications ( n = 3356) were seven times more likely to be from people residing in the poorest areas with high rates of non-employment (75%; n = 1876) and injecting drug use (74%; n = 1862) reported. Notifications among Aboriginal and Torres Strait Islander people were around six times that of non-Indigenous people. HCV notifications negatively correlated (Spearman’s rho − 0.426; p < 0.001) with socio-economic status (residential postcode socio-economic resources Index). History of imprisonment independently predicted HCV diagnoses in lesser economically-resourced areas (RR1.5; p < 0.001). Independent predictors of diagnosis elsewhere than in general practices were non-employment (RR 4.6; p = 0.028), being male (RR 2.5; p < 0.001), and younger than mean age at diagnosis (RR 2.1; p = 0.006). Conclusions Most people diagnosed with HCV were from marginalised sub-populations. Given general practitioners are pivotal to providing effective HCV treatment for many people in Australia a most concerning finding was that non-employed people were statistically less likely to be diagnosed by general practitioners. These findings highlight a need for further action aimed at improving healthcare access and treatment uptake to help reduce the burden of HCV for marginalised people, and progress the vision of eliminating HCV as a major public health threat.

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Section: Discussionmentioning

confidence: 69%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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RETRACTED ARTICLE: The distribution and socioeconomic burden of Hepatitis C virus in South Australia: a cross-sectional study 2010–2016

Edmunds,

Miller,

Tsourtos

2019

BMC Public Health

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“…Yet, identifying everyone infected with HCV, as well as the cost and availability of the newer therapies, remain major barriers. Estimated costs for a 12 week course of treatment currently range from approximately $150 to $500 in countries with voluntary licensing agreements for the use of generic DAAs, to $50,000 in some high-income countries [78]. In the US, this has resulted in the prioritization of patients with advanced liver disease and no substance abuse for treatment with DAAs [79]; however, as of now, newer treat-all recommendations are being introduced [53].…”

Section: Resultsmentioning

confidence: 99%

Hepatitis C virus infection in children: How do we prevent it and how do we treat it?

Nwaohiri

Schillie

Bulterys

et al. 2018

Expert Review of Anti-infective Therapy

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Hepatitis C virus (HCV) infection is an important contributor to the worldwide burden of liver-related morbidity and mortality. Mother-to-child transmission of HCV ranges from 6 to 11% in different populations globally, but accurate estimates on the burden of pediatric HCV infection are limited because screening approaches are not consistent. Areas covered: The advent of new direct-acting antiviral agents that achieve very high rates of sustained virologic response (representing virologic cure) with short (i.e. 8-12 weeks) regimens has revolutionized the field of HCV treatment and led to the development of global elimination goals for HCV transmission and mortality. However, information on their safety during pregnancy and efficacy in preventing mother-to-child transmission is lacking. Currently, there are no approved treatment regimens with these antiviral agents for children younger than 12 years of age. Expert commentary: If these agents are shown to be safe during pregnancy and effective in preventing transmission to the infant, screening of pregnant women and antenatal treatment of those infected, could pave the way for eliminating pediatric HCV infection- particularly as these drugs become less costly and more accessible. Treatment of infected children when indicated, along with universal safe health care practices, can further pediatric HCV elimination.

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“…To achieve the WHO 2030 elimination targets, DAA prices, including those governments or insurers pay per course and for individual patients, must generally fall to ensure universal access [ 95 ]. Governments need to negotiate drug prices and be prepared to use the TRIPS flexibilities to ensure satisfactory results.…”

Section: Ways Forward and Future Challengesmentioning

confidence: 99%

Pathways to ensure universal and affordable access to hepatitis C treatment

Douglass

Pedrana

Lazarus

et al. 2018

BMC Med

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Direct-acting antivirals (DAAs) have dramatically changed the landscape of hepatitis C treatment and prevention. The World Health Organization has called for the elimination of hepatitis C as a public health threat by 2030. However, the discrepancy in DAA prices across low-, middle- and high-income countries is considerable, ranging from less than US$ 100 to approximately US$ 40,000 per course, thus representing a major barrier for the scale-up of treatment and elimination. This article describes DAA pricing and pathways to accessing affordable treatment, providing case studies from Australia, Egypt and Portugal. Pathways to accessing DAAs include developing comprehensive viral hepatitis plans to facilitate price negotiations, voluntary and compulsory licenses, patent opposition, joint procurement, and personal importation schemes. While multiple factors influence the price of DAAs, a key driver is a country’s capacity and willingness to negotiate with pharmaceutical companies. If negotiations do not lead to a reasonable price, governments have the option to utilise flexibilities outlined in the Agreement on Trade-Related Aspects of Intellectual Property Rights. Affordable access to DAAs is underpinned by collaboration between government, civil society, global organisations and pharmaceutical companies to ensure that all patients can access treatment. Promoting these pathways is critical for influencing policy, improving access to affordable DAAs and achieving hepatitis C elimination.

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Targeted direct-acting antiviral treatment for chronic hepatitis C: A financial reality or an obstacle to elimination?

Cited by 6 publications

References 11 publications

RETRACTED ARTICLE: The distribution and socioeconomic burden of Hepatitis C virus in South Australia: a cross-sectional study 2010–2016

RETRACTED ARTICLE: The distribution and socioeconomic burden of Hepatitis C virus in South Australia: a cross-sectional study 2010–2016

Hepatitis C virus infection in children: How do we prevent it and how do we treat it?

Pathways to ensure universal and affordable access to hepatitis C treatment

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