Hospital Pharmacy Management Of Access To Direct-Acting Antivirals For The Treatment Of Hepatitis C And Its Contribution To Public Health And Economic Efficiency – A Single-Center Experience

OBJECTIVES: In February 2015 the Portuguese Ministry of Health (PMH) initiated a new policy granting universal access to direct-acting antivirals (DAA) for the treatment of hepatitis C virus (HCV) infection. The objective of this study was to project the long-term impact of this policy for all patients with authorized treatment at the Centro Hospitalar e Universitario de Coimbra until May 2017. METHODS: Age, gender, metavir, genotype, previous treatment experience and requested DAA were registered for all patients with authorized treatment between February 2015 and May 2017. A discrete-time Markov model was used to estimate the lifetime impact of the new policy on mortality, morbidity and related costs. Mortality endpoints considered were life expectancy and liver-related death. Morbidity was expressed in terms of cirrhosis cases, hepatocellular carcinoma (HCC) and liver transplant (LT). Costs were measured as direct medical costs to the Portuguese NHS. RESULTS: A total of 850 patients were included in this study. Average age of the population was 50.4 years, 76.8% were male. The majority of patients had genotype 1 (66.7%) and were treatment naive (65.4%) and metavir F1 (35.3%). Ledipasvir/sofosbuvir as authorized treatment in 73.8% of the cases. On average, treatment with DAA is expected to increase life expectancy by 6.7 years/patient. We estimate that in this population liver-related death can decrease by 305. Furthermore we anticipated that 472 cases of cirrhosis, 170 cases of HCC and 30 LT could be averted in the long run. This would result into a total saving in direct medical costs of 24.3 million euros, 6.1 million of which due to HCC and 6.0 million due to LT. CONCLUSIONS: Universal access to new generation direct-acting antivirals may contribute to unprecedented gains in patients outcomes and substantial reduce the long term costs for the Portuguese NHS.