Nations Awaiting Price Break in HCV Drugs

When it comes to hepatitis C, drug-makers may hold the health of the world in their hands.

Physicians converging on San Francisco's Moscone Conference Center Saturday to attend the 2015 Liver Meeting (AASLD) had to make their way past demonstrators protesting the high prices of hepatitis C antivirals. But many attendees already had that issue in mind, panelists who spoke at conference session held Monday agreed.

Entitled “Global Challenges and Advances in Hepatitis C Treatment” the session soon evolved into a shared gripe session over the unaffordable costs many nations face in getting direct-acting antivirals (DAAs) to people who need them.

Among the points made:

• The cost is often harder on middle-income nations that are less likely to benefit from price breaks negotiated with pharma companies or subsidies from outside organizations.
• Some nations have been successful in getting major discounts from drug companies.
• Generics are already emerging, but quality is unregulated, leading the World Health Organization to step in to come up with standards and tests.
• Puerto Rico has a particular problem, with a high prevalence of HCV infection, but with its Medicaid program unwilling or unable to cover the cost of DAAs.
• Some countries, notably Egypt, have ambitious programs underway to get the drugs to their residents.
• The US is far ahead of just about all the nations and global regions in getting DAAs to those who need them.

The need for the drugs is most severe in the Asia-Pacific region, said Osamu Yokosuka, MD, of Chiba, Japan. There are between 49 million and 64 million people with hepatitis C living in that region, though good statistics are difficult to come by.

HCV hotspots include Egypt, where about 14.7% of the populace is infected, or 13 million people, and Mongolia, where over 15% of the population or 500,000 people have the virus.

Access to DAAs varies, with interferon remaining the standard of care in most places. DAAs are available in Australia, India, Taiwan and Turkey. “Unfortunately they are very expensive,” said Ayman Yosry, MD. Turkey launched a government program to get DAAs to those who need them and though 1.138 million people registered to take part, only 40% showed up for treatment. So far 134,000 patients have started treatment and 86% have shown a sustained viral response. “We get a lot of dropouts,” he said.

Still the nation is aiming to get treatment to all by 2030. That would mean a 77% drop in liver cancer mortality he said. “The challenge is getting the drugs at an affordable price and convincing government to pay,” Yosry said. He also advocated for “punitive legislation for disease transmission to be made mandatory,” but did not elaborate.

The picture in the Dominican Republic is bright, said Fernando Contreras, MD, addressing the issue of access to DAAs in Latin America.

But “robust data” on infection rates is sorely lacking. Much work needs to be done in healthcare-acquired infections as well, he said, which are blamed for much of the spread of the virus.

He said the Dominican Republic successfully negotiated for major discounts with pharma companies. That is not true for all of Latin America, he said. He urged others to “sit down with pharma” and work to get better prices. Political activism is also essential. “Make this a problem for politicians," he said.