Farmaci Epatite C

Access to Direct-Acting Antiviral Therapy for Hepatitis C: the barriers imposed by USA

Direct antiviral agents (DAA) for the treatment of chronic hepatitis C virus (HCV) infection showed high rates of cure, approaching 95% success. Based on these results some scientific societies have hypothesized complete viral eradication in a couple of decades if DAA treatment is given to all chronic HCV-infected patients. However, the high costs of DAAs is a major concern even for developed countries, which have restricted the access to these medications to patients with advanced liver fibrosis and/or abstinence from alcohol or illicit drug use. These restrictions are applied also in USA, despite that the National Academies of Sciences, Engineering, and Medicine has recommended DAA treatment for all chronic HCV-infected patients, foreseeing the elimination of HCV by 2030. In USA, healthcare is funded by private insurance companies but also by public insurance, which in theory should not limit the access to treatment for mere economic reasons. Recently, investigators from Ohio and Pennsylvania published a prospective study, which shows that denials of DAA regimens by insurers has remained high. The study evaluated 9025 patients who had a DAA prescription submitted from January 2016 to April 2017 (16 months) in 45 states of USA, and found that 3200 patients were denied treatment. Even though there were differences in denial among the various types of insurance, on the whole about 1/3 of patients had no access to DAA treatment. Moreover, rather unexpectedly, denial increased during the study period (from 27.7% in first quarter of the study to 43.8% in last quarter), regardless of the insurance type.

Despite several pharmacoeconomic studies have underscored the long term financial advantages of DAA treatment, deriving from the reduction of mortality and severe complications associated with liver cirrhosis due to HCV infection, the trend towards an increased denial continues. The authors of the aforementioned study emphasize the necessity of reversing this trend by increasing the number of patients eligible for DAA treatment in order to avoid the hepatic and extrahepatic complications of HCV infection and eventually reach the goal of eradicating the virus.


Absolute Insurer Denial of Direct-Acting Antiviral Therapy for Hepatitis C: A National Specialty Pharmacy Cohort Study

Gowda C, Lott S, Grigorian M, Carbonari DM, Saine ME, Trooskin S, Roy JA, Kostman JR, Urick P, Lo Re V 3rd.
Absolute Insurer Denial of Direct-Acting Antiviral Therapy for Hepatitis C: A National Specialty Pharmacy Cohort Study
Open Forum Infect Dis 2018;7:5(6):ofy076.