Cost and Effectiveness of the Treatment of Chronic Hepatitis C in Brazil: Real-World Data

• Published in: Value in health regional issues Vol. 23; pp. 49 - 54
• Main Authors: Schwambach, Karin Hepp, Farias, Mareni Rocha, Neto, Giácomo Balbinotto, Blatt, Carine Raquel
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01-12-2020
• Subjects: effectiveness of treatment; health technology assessment; hepatitis C; medicine costs; public policies; health technology assessment; medicine costs; hepatitis C; effectiveness of treatment; public policies
• ISSN: 2212-1099; 2212-1102
• DOI: 10.1016/j.vhri.2020.05.002

To introduce and discuss the cost and effectiveness of using sofosbuvir, daclatasvir, and simeprevir antivirals, in combination or not with peginterferon alfa and ribavirin, for the treatment of hepatitis C, as based on real-world data.
We analyzed the treatment and outcomes of 253 patients from a retrospective cohort held in a specialized assistance service in the municipality of Porto Alegre, Brazil. Regarding costs, we considered only the direct costs of the antiviral medications per unit (pills), according to the financial receipts of the public procurements. We calculated the total cost of treatment per individual and the cost per cure expressed in sustained virologic response (SVR).
Most patients (66.8%) were carriers of the genotype 1 of hepatitis, and 92.9% reached the SVR. The average cost of the treatment for genotype-1 patients was $5,862.31 USD per patient and $6,310.34 for the cure; for genotype-3 patients, on the other hand, the cost was $5,144.27 per patient and $5,974.76 for the cure. The drugs purchasing cost was around 40% less than was estimated for the process of incorporating them into the public health system.
The results indicated that good rates of effectiveness were achieved with different combinations of the medicines. The costs of the medicines were still deemed too high for the Brazilian reality, however. Therefore the results contribute to support the formulation and review of public policies based on strong evidence and on real-world data for the treatment of hepatitis C.
•Hepatitis C is considered a global public health issue. The emergence in recent years of treatment options with high levels of efficacy and safety, but which also bear a high cost, has emphasized the need to study the disease from an economic point of view.•This work analyzes the incorporation to the public health system of sofosbuvir, daclatasvir, and simeprevir and is based on real-world data. The results indicated that good rates of effectiveness were achieved with different combinations of the medicines for Hepatitis C treatment. The cost of purchasing the drugs was around 40% less than was estimated; however, the cost of the medicines is still too high for Brazil.•Centralizing procurement and making negotiations within the industry are proving to be good strategies for reducing the paid amounts. The results show the primary data of effectiveness and cost in a real-world scenario that may help future economic evaluations, and we address the importance of negotiating the prices of medicines to guarantee access.