Letters
Digestive system diseases
Volume 202 - Issue 9

HCV-infected patients need access now to new direct-acting antiviral agents to avert liver-related deaths

Authors:  William Sievert, Homie Razavi, Alexander Thompson, Amany Zekry, Gregory J Dore and Stuart Keith Roberts

Med J Aust 2015; 202 (9): 479. || doi: 10.5694/mja15.00165
Published online: 18 May 2015
Direct-acting antiviral agents are expensive, but offer a chance of cure
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To the Editor: We recently used a modelling approach to describe how the burden of infection with hepatitis C virus (HCV) and the associated health care costs in Australia will increase as the infected population ages.1 We showed that increasing the efficacy of antiviral therapy and the number of patients treated could avert the expected increase in deaths from HCV-related liver disease and in the number of patients with end stage HCV-related liver disease. We did not include the specific costs of new direct-acting antiviral (DAA) regimens, as these are yet to be determined in Australia. We know that the cost of the new regimens has elicited discussion internationally about the ability of payers to meet those costs.

Importantly, compared with previous regimens, DAA therapies offer higher cure rates, simplified dosing, shorter treatment duration and are better tolerated — albeit at a substantial price.

Given the difficult decisions that will need to be made by the Australian Government, we examined the impact of delayed access to DAA treatment by modelling 1-year and 2-year delays. Currently, an estimated 2550 patients are treated with interferons and/or first-generation protease inhibitors.1 In the DAA scenario, we assumed cure rates of over 90%, drug availability in 2015 and an increase in the number of patients treated to 3550 in 2015, 7100 in 2016 and 14 000 after 2018. To provide the chance of cure of HCV infection to those at greatest risk, we limited treatment to advanced liver fibrosis (stage F3 or F4) from 2015 to 2017, with no restriction on the stage of fibrosis beginning in 2018. Based on those assumptions, we then compared the cumulative incident cases of liver-related deaths, decompensated cirrhosis, and hepatocellular carcinoma from 2014 to 2030. Under no circumstance did we consider that DAAs would never be available, thus the 1-year and 2-year delay scenarios were only compared with the DAA scenario (Box).

While other scenarios could be considered, we believe that it is important to remember that an estimated 230 000 people in Australia are chronically infected with HCV,1 and those with advanced liver disease remain at greatest risk of liver-related death. We believe that it is critical to provide patients with access to highly effective therapeutic regimens to cure HCV infection without delay to diminish future HCV-related morbidity and mortality.

Projected cumulative new cases of hepatitis C-related advanced liver disease and death with current treatments compared with direct-acting antiviral (DAA) agents from 2014 to 2030, inclusive, plus projected new cases if access to DAA agents is delayed for 1 or 2 years

 

Cumulative new cases

Treatment

Liver-related deaths

Decompensated cirrhosis

Hepatocellular carcinoma

Current treatments

22 200

19 100

13 500

DAAs

13 500

11 000

8 200

DAAs, 1-year delay

14 400

11 800

8 700

DAAs, 2-year delay

15 300

12 600

9 200

Impact of delay

   

1-year

900

800

500

2-year

1 800

1 600

1 000

Authors

  • William Sievert MD, FRACP1
  • Homie Razavi PhD2
  • Alexander Thompson MB BS(Hons), PhD, FRACP3
  • Amany Zekry MB BS, PhD, FRACP4
  • Gregory J Dore MB BS, FRACP, PhD5
  • Stuart Keith Roberts MD, FRACP, FAASLD6
  • 1. Monash Health and Monash University, Melbourne, VIC.
  • 2. Center for Disease Analysis, Louisville, Colorado, USA.
  • 3. St Vincent's Hospital Melbourne, Melbourne, VIC.
  • 4. St George Hospital, Sydney, NSW.
  • 5. Kirby Institute for Infection and Immunity in Society, Sydney, NSW.
  • 6. Alfred Hospital, Melbourne, VIC.

Correspondence: william.sievert@monash.edu

Competing interests

William Sievert has been a member of advisory boards and a clinical investigator for Bristol Myers Squibb (BMS), Gilead Sciences, Merck, Janssen and AbbVie. Homie Razavi is a director at the Center for Disease Analysis (CDA) and has not received any direct financial remuneration from outside organisations. CDA receives support from public and private firms (Gilead Sciences, AbbVie, and Merck) for non-product related research projects. Alexander Thompson has been a consultant for Gilead, Abbvie, Bristol-Myers Squibb (BMS), Janssen, Merck, and Roche, and a principal investigator for Gilead, Merck, Roche, BMS, Janssen, Arrowhead and Springbank; he has also received research and grant support from Gilead, Merck, BMS and Abbvie. Amany Zekry has been a member of advisory boards and a clinical investigator for BMS, Gilead Sciences, Merck, and AbbVie. Gregory Dore has been a member of advisory boards and a clinical investigator for BMS, Gilead Sciences, Merck, AbbVie, and Janssen. Stuart Roberts has been a member of advisory boards and a clinical investigator for BMS, Gilead Sciences, Merck, Janssen and AbbVie.

References

View this article on Wiley Online Library

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