Background In order to bring prescriptions for the use of direct-acting antiviral agents (DAAs) for the treatment of HCV genotype 1 infection in mono and co-infected patients in line with the recommendations of the Spanish Health System under the current economic conditions, a local committee formed by an Infectious Disease specialist, a Gastroenterologist and a Hospital Pharmacist was created in our Health Care Area.
Purpose To evaluate the economic impact of prioritising treatments with DAAs decided by a local committee in a Health Care Area over 18 months.
Materials and methods Observational, retrospective study from April 12 to September 13. Viral genotype was ascertained, as well as liver stiffness by ultrasound-based transient elastography (FibroScan) and IL-28 polymorphism. Patients were classified based on previous treatment with peginterferon-ribavirin (treatment-naïve, relapser, partial-responder, non-responder or with unknown previous response). By agreement between the Medical Director, Pharmacy, Gastroenterology and Infectious Disease Services, patients considered eligible for treatment with DAAs were those with stage F3-F4 fibrosis and those relapsers whose liver stiffness was >8.5 kpa. Medical records and laboratory data of all patients with a request for treatment with DAAs were reviewed as well as the decision taken by the Commission (accepted/denied). The cost with triple therapy in HCV genotype 1 was estimated to be 40,000 € per patient (treatment and supportive treatment). Data was analysed using SPSS.
Results 56 treatment requests were finally evaluated. Depending on previous treatment, patients were treatment-naïve (46.42%), relapsers (37.5%), partial-responders (10.71%) and non-responders (5.35%). Classed by stage of fibrosis, they were F0-F2 (25%), F3-F4 (57.14%), and 17.85% had no recent fibrosis test (neither FibroScan nor biopsy). 93.9% of accepted prescriptions corresponded to F3-F4 patients and the remaining 6.1% were two exceptions to the current HCV therapy recommendations of the Spanish Health System (one F2 treatment-naïve woman with childbearing intentions and one F2 treatment-naïve man with special working conditions). 23 (41.1%) patients were considered not eligible for triple therapy with DAAs. That resulted in a cost saving of 880,000 € (one of them had no indication for treatment (F0-F1), so was not included).
Conclusions The creation of a local committee with powers to prioritise triple therapy with DAAs to those patients with more advanced liver disease and to defer such treatment of those in the early stages (hoping for new, better and safer drugs) has already generated important cost savings in our Health Care Area.
No conflict of interest.
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