scholarly journals Treatment Coverage and Drug Expenditure in Hepatitis C Patients From 2013 to 2019: A Journey of Improving Treatment Accessibility in Malaysia Through Government-led Initiatives

2020 ◽  
Vol 20 (9) ◽  
Author(s):  
Huan-Keat Chan ◽  
Mohamed Azmi Hassali ◽  
Rosaida Md Said ◽  
Muhammad Radzi Abu Hassan
Keyword(s):  
Public Health ◽  
Hepatitis C ◽  
Compulsory License ◽  
Drug Expenditure ◽  
Treatment Coverage ◽  
Non Profit ◽  
Direct Acting Antiviral ◽  
Number Of Patients ◽  
Public Health Institutions ◽  
Direct Acting

Background: Hepatitis C is a public health threat, affecting approximately 1.9% of the Malaysian population. Objectives: This study demonstrates how a series of initiatives taken by the Ministry of Health (MOH) of Malaysia have impacted the treatment coverage and drug expenditure for hepatitis C patients since 2013, the year in which the first direct-acting antiviral (DAA) was introduced in public health institutions. Methods: The data were obtained from all the 144 hospitals and 33 primary healthcare centers throughout the country, which were identified to have offered the pharmacological treatment to hepatitis C patients over the last seven years. Results: The total number of hepatitis C patients treated each year was shown to increase by more than 10 times, reaching 3,116 in 2019. However, the drug expenditure for hepatitis C relative to the overall health expenditure did not significantly increase over time (P = 0.094). The use of DAAs was once limited by its exorbitant cost. A remarkable elevation in the number of patients receiving the treatment only took place as of 2016, particularly following the engagement of the MOH in endeavors driven by non-profit organizations to enhance the accessibility of DAAs and the issuance of a compulsory license to sofosbuvir. Conclusions: Timely decisions of the MOH and the judicious use of policy tools were shown to have transformed the landscape of hepatitis C management in Malaysia without considerably raising the budgetary pressure. Yet, continuous efforts to massively upscale the screening and treatment of the disease are warranted going forward.

scholarly journals NON-ADHERENCE TO HEPATITIS C TREATMENT: A BRAZILIAN REPORT

2021 ◽  
Vol 58 (4) ◽  
pp. 456-460
Author(s):  
Claudia Alexandra Pontes IVANTES ◽  
Bernardo Carvalho da SILVA ◽  
Gabriel Gonçalves ACOSTA ◽  
Fabiane Beatriz Neves El TAWIL ◽  
Renato NISIHARA
Keyword(s):  
Public Health ◽  
Hepatitis C ◽  
Health System ◽  
Public Health System ◽  
Epidemiological Data ◽  
Hepatitis C Treatment ◽  
The Public ◽  
Direct Acting Antiviral ◽  
Private Medicine ◽  
Direct Acting

ABSTRACT BACKGROUND: In Brazil, since 2015, the treatment of hepatitis C is provided by SUS (Public Health System) with direct-acting antiviral (DAA). OBJECTIVE: To describe the rate of non-adherence patients to hepatitis C treatment by DAA, investigating the epidemiological data in a large database from Curitiba, Brazil. METHODS: Retrospective study with patients treated between January 2015 and June 2019. Patients were considered adherent when received all medication doses during their treatment. The following data were evaluated: gender, age, type of treatment, period of treatment, presence of diabetes or HIV, previous therapy, originated from SUS or private medicine, fibrosis grade and HCV genotype. RESULTS: 1248 patients (56.8% males) were studied and 102/1248 (8.2%) were non-adherent to treatment. Age or gender not influenced significantly; 10.2% patients from SUS and 3.7% individuals from private medicine were non-adherent (P<0.0001; OR=2.9; CI95%=1.6-9.1); 13.1% patients were co-infected with HIV and among them, 15.9% abandoned treatment. Individuals without co-infection presented 7.0% of non-adherence (P<0.0001; OR=2.5; CI=1.5-4.1). All the other variables showed no differences in the adhesion rate. CONCLUSION: Our study showed that 8.2% of patients were non-adherent to HCV treatment, and that patients from the Public Health System and co-infected with HIV were significantly less adherent.

scholarly journals The case for a universal hepatitis C vaccine to achieve hepatitis C elimination

BMC Medicine ◽  
2019 ◽  
Vol 17 (1) ◽  
Author(s):  
Nick Scott ◽  
David P. Wilson ◽  
Alexander J. Thompson ◽  
Eleanor Barnes ◽  
Manal El-Sayed ◽  
...  
Keyword(s):  
Public Health ◽  
Hepatitis C ◽  
Vaccine Development ◽  
Treatment As Prevention ◽  
Test And Treat ◽  
Direct Acting Antiviral ◽  
Community Transmission ◽  
Efficacious Vaccine ◽  
Health Need ◽  
Direct Acting

Abstract Background The introduction of highly effective direct-acting antiviral (DAA) therapy for hepatitis C has led to calls to eliminate it as a public health threat through treatment-as-prevention. Recent studies suggest it is possible to develop a vaccine to prevent hepatitis C. Using a mathematical model, we examined the potential impact of a hepatitis C vaccine on the feasibility and cost of achieving the global WHO elimination target of an 80% reduction in incidence by 2030 in the era of DAA treatment. Methods The model was calibrated to 167 countries and included two population groups (people who inject drugs (PWID) and the general community), features of the care cascade, and the coverage of health systems to deliver services. Projections were made for 2018–2030. Results The optimal incidence reduction strategy was to implement test and treat programmes among PWID, and in settings with high levels of community transmission undertake screening and treatment of the general population. With a vaccine available, the optimal strategy was to include vaccination within test and treat programmes, in addition to vaccinating adolescents in settings with high levels of community transmission. Of the 167 countries modelled, between 0 and 48 could achieve an 80% reduction in incidence without a vaccine. This increased to 15–113 countries if a 75% efficacious vaccine with a 10-year duration of protection were available. If a vaccination course cost US$200, vaccine use reduced the cost of elimination for 66 countries (40%) by an aggregate of US$7.4 (US$6.6–8.2) billion. For a US$50 per course vaccine, this increased to a US$9.8 (US$8.7–10.8) billion cost reduction across 78 countries (47%). Conclusions These findings strongly support the case for hepatitis C vaccine development as an urgent public health need, to ensure hepatitis C elimination is achievable and at substantially reduced costs for a majority of countries.

scholarly journals Liver Pathologic Changes After Direct-Acting Antiviral Agent Therapy and Sustained Virologic Response in the Setting of Chronic Hepatitis C Virus Infection

2020 ◽  
Author(s):  
Romulo Celli ◽  
Saad Saffo ◽  
Saleem Kamili ◽  
Nicholas Wiese ◽  
Tonya Hayden ◽  
...  
Keyword(s):  
Hepatitis C ◽  
Liver Tissue ◽  
Sustained Viral Response ◽  
Antiviral Agent ◽  
Hcv Infection ◽  
Hcv Rna ◽  
Direct Acting Antiviral ◽  
Viral Hepatitis C ◽  
Number Of Patients ◽  
Direct Acting

Context.— Treatment of chronic viral hepatitis C (HCV) infection with direct-acting antiviral agents (DAAs) results in cure, or sustained viral response (SVR), in more than 90% of patients. However, there are subsets of patients who have persistent liver inflammation and fibrosis and develop hepatocellular carcinoma (HCC) despite achieving SVR. A possible reason for these phenomena may be the presence of virus particles in liver tissue but not blood, otherwise defined as occult infection. Objective.— To describe liver histologic findings following successful DAA therapy, test HCV RNA by (liver) tissue polymerase chain reaction in treated cases, and identify predictive markers for HCC development in treated cases. Design.— A total of 96 identified patients were divided into 4 groups, each differentiated by the presence or absence of SVR and HCC. Groups were compared for several clinicopathologic variables, including degree of inflammation and fibrosis, and the ‘directionality' of fibrosis in cirrhotic livers using the novel progressive-indeterminate-regressive scoring system. Results.— Overall, we found a significant decrease in inflammation in SVR patients. None of the patients showed regression of their cirrhosis following treatment. No evidence of occult HCV infection was seen in 40 livers tested, including 21 with HCC. The number of patients who developed HCC was similar in the SVR and non-SVR groups, and increased inflammation and fibrosis were associated with HCC development. Conclusions.— Following DAA-SVR there appears to be an overall decrease in inflammation, but the fibrosis tends to persist, at least in the short term (median follow-up of 20.2 months).

scholarly journals THE USE OF DIRECT-ACTING ANTIVIRALS FOR THE TREATMENT OF CHRONIC HEPATITIS C IN PATIENTS WITH HEMOPHILIA

2020 ◽  
Vol 4 (2) ◽  
pp. 184-188
Author(s):  
D. E. Danilau ◽  
Keyword(s):  
Chronic Hepatitis ◽  
Hepatitis C ◽  
Chronic Hepatitis C ◽  
Hematological Parameters ◽  
Antiviral Treatment ◽  
Virologic Response ◽  
Direct Acting Antiviral ◽  
Number Of Patients ◽  
Direct Acting ◽  
Alt Activity

Background. Worldwide, prior to 1990, a large number of patients with hemophilia were infected with the hepatitis C virus due to substitution therapy. The mortality rate from chronic liver disease and HCC in patients with HCV and hemophilia is signifcantly higher than in general population. Objective. To assess the results of direct-acting antiviral therapy in patients with hemophilia and chronic hepatitis C. Material and methods. The rate of sustained virologic response after DAA treatment and the dynamics of clinical and laboratory parameters during antiviral treatment were evaluated. Results. All 14 patients achieved sustained virological response after 12 / 24 weeks of treatment. During antiviral treatment, some patients showed an increase in blood urea nitrogen, a decrease in leukocyte count, and increase of ALT activity. All these phenomena were reversible and resolved spontaneously. Conclusion. The DAA regimens available in Belarus are highly effective for the treatment of chronic hepatitis C in patients with hemophilia. These regimens do not signifcantly affect hematological parameters, are well tolerated, and have acceptable safety profle.

New Epidemiologic Data Regarding Hepatitis C Virus Infection in Romania

2017 ◽  
Vol 26 (4) ◽  
pp. 381-386
Author(s):  
Mircea Manuc ◽  
Carmen M. Preda ◽  
Corneliu P. Popescu ◽  
Cristian Baicuș ◽  
Theodor Voiosu ◽  
...  
Keyword(s):  
Hepatitis C Virus ◽  
Hepatitis C ◽  
Drug Users ◽  
Antiviral Agent ◽  
Virologic Response ◽  
Advanced Fibrosis ◽  
Direct Acting Antiviral ◽  
Genotype 1B ◽  
Direct Acting ◽  
End Stage

Background & Aims: Literature data suggest that HCV genotype-1b is present in 93-99% of the Romanian patients infected with hepatitis C virus (HCV). We present the genotyping tests recently performed on patients with HCV and advanced fibrosis eligible for the Direct-Acting Antiviral (DAA) therapy, as well as the prevalence of these cases across Romania.Methods: The genotyping method was performed on 7,421 HCV patients with advanced fibrosis. The detection method was automatic real time PCR platform M2000 (Abbott). Every subject was introduced into a database including age, sex, county and address.Results: Genotype 1b was almost exclusively present: 7,392/7,421 (99.6%). Genotype 1b patients were 19.6% from Bucharest, 49% were males, with a median age of 60 years. Genotype non-1b was encountered in 29/7,421 subjects (0.4%), 62% were males, 69% from Bucharest and the median age was 52 years. Most of the subjects (75%) were in the 6th and 7th age decade. The prevalence of these cases varied significantly across Romanian counties: the highest was in Bucharest (61.3/105), Bihor (47/105), Iasi (46/105) and Constanța (43/105), and the lowest in Ilfov (2.8/105), Harghita (3.7/105), Covasna (5.4/105) and Maramureș (8.8/105) (p<0.001).Conclusions: Genotype 1b is encountered in 99.6% of patients with chronic hepatitis C and advanced fibrosis from Romania. The presence of genotypes non-1b is more common in Bucharest, in males and at a younger age. There are significant differences regarding the distribution of these cases across Romania: the highest rates are in Bucharest, Bihor, Iasi and Constanta.Abbreviations: BMI: body mass index; DAA: direct-acting antiviral agent; GT: genotype; HBV: hepatitis B virus; HCC: hepatocellular carcinoma; HCV: hepatitis C virus; IDU: intravenous drug users; MELD: model for end stage liver disease; NASH: non-alcoholic steatohepatitis; SVR; sustained virologic response.

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