Restricted Reimbursement for DAAs Hinders Progress Towards Global Hepatitis C Eradication Goal

There are significant differences in the criteria for reimbursing for direct-acting antivirals (DAAs) for patients with hepatitis C virus (HCV) among the provinces in Canada, according to the results of a recent study. Conducted by Alison Marshall, MA, of The Kirby Institute, and colleagues, the study was published in the CMJ Open on October 14, 2016.

Although DAAs achieve sustained virologic response (SVR) rates above 90%, they are expensive. The researchers say that there are about 220,000 people with HCV in Canada, and add that, “given that the list price for HCV direct-acting antivirals in Canada is about $60,000 for a 12-week course, funding all those chronically infected with HCV presents challenges.”

“The aim of this study,” say the authors, “was to appraise reimbursement criteria in Canada for simeprevir, sofosbuvir, ledipasvir-sofosbuvir and paritaprevir-ritonavir-ombitasvir plus dasabuvir.” Additionally, they reviewed the criteria for two groups who experience disproportionate rates of HCV and receive coverage from national plans -- Aboriginal people and federal prisoners.

The primary outcomes for this study were based on a previous American study that examined Medicaid reimbursement for DAAs. That study and the present one both organized information into four categories, described by the authors as, “1) minimum fibrosis stage required, 2) drug and alcohol use restrictions, 3) HIV coinfection restrictions, and 4) prescriber type restrictions.”

“We found variability in criteria for reimbursement of HCV direct-acting antivirals by jurisdiction in Canada,” report the researchers. Specifically, reimbursements to patients with fibrosis stage F2 or greater were limited in 85-92% of the territories and provinces, depending on the treatment. Another difference was in who could prescribe the DAAs, with 23-42% of the jurisdictions limiting it to specialists. There were no drug and alcohol use restrictions; and only Quebec listed restrictions for those coinfected with HIV.

The researchers suggest that restrictions are not cost-effective nor are they evidence based. They say, “To achieve World Health Organization HCV elimination targets by 2030, increased uptake of HCV therapy, especially by people who inject drugs, is essential to reduce HCV incidence and contribute to viral elimination in Canada.”

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