1
|
Gari MH, Alsuhibani A, Alashgar A, Guo JJ. Utilization, reimbursement, and price trends for Hepatitis C virus medications in the US Medicaid programs: 2001-2021. EXPLORATORY RESEARCH IN CLINICAL AND SOCIAL PHARMACY 2023; 12:100383. [PMID: 38145237 PMCID: PMC10746553 DOI: 10.1016/j.rcsop.2023.100383] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Revised: 11/10/2023] [Accepted: 11/25/2023] [Indexed: 12/26/2023] Open
Abstract
Background Hepatitis C Virus (HCV) remains a challenging health problem worldwide, with increasing incidence despite being curable with Direct Acting Antiviral (DAA) agents. Objective This study aimed to describe the utilization, reimbursement, and price trends of HCV treatments and evaluate the influence of treatment guidelines and policies. Methods A retrospective, descriptive drug utilization study conducted using the outpatient pharmacy data extracted from the Centers for Medicaid and Medicare Services State Drug Utilization Data between 2001 and 2021. All HCV treatments approved in the US were included, conventional therapy (CT), and DAA agents. The annual secular trends were calculated for each medication's total number of prescriptions, reimbursements, and prices. The average reimbursement per prescription was calculated and utilized as a proxy of prices. The HCV treatment guideline and policies and legislation were evaluated overtime to measure the impact on the trends. Results Despite CT having a higher total utilization, DAA agents commanded significantly greater reimbursements, with 4.1 billion USD for CT and 19.45 billion USD for DAA agents. CT utilization increased rapidly and dominated the market until 2011, peaking at 379,696 prescriptions in 2003 but declining afterward. DAA agents' utilization increased rapidly in their first year: i.e., sofosbuvir reached 50,377 prescriptions with 1.3 billion USD in 2014, while ledipasvir/sofosbuvir reached 79,387 prescriptions with 2 billion USD in 2015. The average price per prescription was high for the DAA agents, like 24,992 USD for sofosbuvir and 22,787 USD for ledipasvir/sofosbuvir, compared to CT medications ribavirin, around 500 USD, and pegINF, around 3000 USD. The new DAA agents replaced CT, and initiating market competition among DAA agents. Conclusion The introduction of multiple DAA agents slightly changed their prescription prices but remained high during the study period. The recent increase in HCV incidence cases indicates accessibility issues for costly and effective DAA agents, with treatment guidelines and policies playing a critical role in shaping these trends.
Collapse
Affiliation(s)
- Musaab H. Gari
- James L. Winkle College of Pharmacy, University of Cincinnati Academic Health Center, Cincinnati, OH 45267, USA
| | - Abdulrahman Alsuhibani
- James L. Winkle College of Pharmacy, University of Cincinnati Academic Health Center, Cincinnati, OH 45267, USA
- Department of Pharmacy Practice, Unaizah College of Pharmacy, Qassim University, Saudi Arabia
| | - Amin Alashgar
- James L. Winkle College of Pharmacy, University of Cincinnati Academic Health Center, Cincinnati, OH 45267, USA
- Department of Pharmacy Practice, Unaizah College of Pharmacy, Qassim University, Saudi Arabia
| | - Jeff J. Guo
- James L. Winkle College of Pharmacy, University of Cincinnati Academic Health Center, Cincinnati, OH 45267, USA
| |
Collapse
|
2
|
Pabjan P, Brzdęk M, Chrapek M, Dziedzic K, Dobrowolska K, Paluch K, Garbat A, Błoniarczyk P, Reczko K, Stępień P, Zarębska-Michaluk D. Are There Still Difficult-to-Treat Patients with Chronic Hepatitis C in the Era of Direct-Acting Antivirals? Viruses 2022; 14:96. [PMID: 35062302 PMCID: PMC8779728 DOI: 10.3390/v14010096] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2021] [Revised: 12/29/2021] [Accepted: 01/04/2022] [Indexed: 12/17/2022] Open
Abstract
Difficult-to-treat populations with chronic hepatitis C (CHC), in the era of interferon treatment, included patients with liver cirrhosis, kidney impairment, treatment-experienced individuals, and those coinfected with the human immunodeficiency virus. The current study aimed to determine whether, in the era of direct-acting antivirals (DAA), there are still patients that are difficult-to-treat. The study included all consecutive patients chronically infected with hepatitis C virus (HCV) who started interferon-free therapy between July 2015 and December 2020 in the Department of Infectious Diseases in Kielce. The analyzed real-world population consisted of 963 patients, and most of them were infected with genotype 1 (87.6%) with the predominance of subtype 1b and were treatment-naïve (78.8%). Liver cirrhosis was determined in 207 individuals (21.5%), of whom 82.6% were compensated. The overall sustained virologic response, after exclusion of non-virologic failures, was achieved in 98.4%. The univariable analysis demonstrated the significantly lower response rates in males, patients with liver cirrhosis, decompensation of hepatic function at baseline, documented esophageal varices, concomitant diabetes, body mass index ≥25, and previous ineffective antiviral treatment. Despite an overall very high effectiveness, some unfavorable factors, including male gender, genotype 3 infection, liver cirrhosis, and treatment experience, significantly reduce the chances for a virologic response were identified.
Collapse
Affiliation(s)
- Paweł Pabjan
- Department of Infectious Diseases, Voivodship Hospital, Jan Kochanowski University, 25-317 Kielce, Poland; (P.P.); (K.P.); (A.G.); (P.B.); (K.R.); (P.S.)
| | - Michał Brzdęk
- Collegium Medicum, Jan Kochanowski University, 25-369 Kielce, Poland; (M.B.); (K.D.); (K.D.)
| | - Magdalena Chrapek
- Faculty of Natural Sciences, Jan Kochanowski University, 25-369 Kielce, Poland;
| | - Kacper Dziedzic
- Collegium Medicum, Jan Kochanowski University, 25-369 Kielce, Poland; (M.B.); (K.D.); (K.D.)
| | - Krystyna Dobrowolska
- Collegium Medicum, Jan Kochanowski University, 25-369 Kielce, Poland; (M.B.); (K.D.); (K.D.)
| | - Katarzyna Paluch
- Department of Infectious Diseases, Voivodship Hospital, Jan Kochanowski University, 25-317 Kielce, Poland; (P.P.); (K.P.); (A.G.); (P.B.); (K.R.); (P.S.)
| | - Anna Garbat
- Department of Infectious Diseases, Voivodship Hospital, Jan Kochanowski University, 25-317 Kielce, Poland; (P.P.); (K.P.); (A.G.); (P.B.); (K.R.); (P.S.)
| | - Piotr Błoniarczyk
- Department of Infectious Diseases, Voivodship Hospital, Jan Kochanowski University, 25-317 Kielce, Poland; (P.P.); (K.P.); (A.G.); (P.B.); (K.R.); (P.S.)
| | - Katarzyna Reczko
- Department of Infectious Diseases, Voivodship Hospital, Jan Kochanowski University, 25-317 Kielce, Poland; (P.P.); (K.P.); (A.G.); (P.B.); (K.R.); (P.S.)
| | - Piotr Stępień
- Department of Infectious Diseases, Voivodship Hospital, Jan Kochanowski University, 25-317 Kielce, Poland; (P.P.); (K.P.); (A.G.); (P.B.); (K.R.); (P.S.)
| | - Dorota Zarębska-Michaluk
- Department of Infectious Diseases, Voivodship Hospital, Jan Kochanowski University, 25-317 Kielce, Poland; (P.P.); (K.P.); (A.G.); (P.B.); (K.R.); (P.S.)
| |
Collapse
|
3
|
Zarębska-Michaluk D. Viral hepatitis C treatment shortening - what is the limit? Clin Exp Hepatol 2019; 5:265-270. [PMID: 31893236 PMCID: PMC6935848 DOI: 10.5114/ceh.2019.88085] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2019] [Accepted: 08/20/2019] [Indexed: 12/24/2022] Open
Abstract
Successful antiviral treatment for hepatitis C virus (HCV) infection is crucial to prevent progression of the disease and its most serious complications. Therapy options have changed over the years with improvement of treatment efficacy, safety and simplification. They evolved from interferon and ribavirin combination administered for 24-72 weeks through interferon (IFN)-based triple therapies with 24-48 weeks duration to the all-oral, well-tolerated direct-acting antiviral regimens lasting for 8-16 weeks and with almost 100% cure rates. The benefits of shorter treatment duration are cost reduction, access to therapy for more patients, and lower risk of adverse events and nonadherence. This review summarizes data on treatment options, focusing on the recommended durations of different regimens depending on HCV genotype, severity of liver disease and history of previous therapy. According to currently available data, shortening treatment below 8 weeks does not provide additional benefits, although the further simplification of therapy is still a subject of study.
Collapse
|
4
|
Preda CM, Popescu CP, Baicus C, Voiosu TA, Manuc M, Pop CS, Gheorghe L, Sporea I, Trifan A, Tantau M, Tantau A, Ceausu E, Proca D, Constantinescu I, Ruta SM, Diculescu MM, Oproiu A. Real-world efficacy and safety of ombitasvir, paritaprevir/r+dasabuvir+ribavirin in genotype 1b patients with hepatitis C virus cirrhosis. Liver Int 2018; 38:602-610. [PMID: 28816020 DOI: 10.1111/liv.13550] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2017] [Accepted: 08/10/2017] [Indexed: 02/05/2023]
Abstract
BACKGROUND Direct antiviral agents (DAA) showed very good results in terms of efficacy and safety in clinical trials, but real-life data are still needed in order to confirm this profile. MATERIAL AND METHODS In Romania, through a nationwide government-funded programme in 2015-2016, approx.5800 patients with virus C cirrhosis received fully reimbursed DAA therapy with OBV/PTV/r+DSV+RBV for 12 weeks. We analysed a national prospective cohort enrolling the first 2070 patients, all with genotype 1b. The only key inclusion criteria was advanced fibrosis (Metavir stage F4) confirmed by Fibromax testing (or liver biopsy/Fibroscan). Efficacy was assessed by the percentage of patients achieving SVR 12 weeks post-treatment (SVR12). RESULTS Forty patients stopped the treatment because of hepatic decompensation (1.9%), 21 stopped because of other adverse events and one was lost to follow-up. This cohort was 51% females, mean age 60 years (25÷82), 67% pretreated, 70% associated NASH, 67% with severe necro-inflammation (severity score 3-Fibromax), 37% with comorbidities, 10.4% with Child Pugh A6, 0.5% B7. The median MELD score was 8.09 (6 ÷ 22). SVR by intention-to-treat was reported in 1999/2070(96.6%), 55/2070 failed to respond. Liver decompensation was statistically associated in multivariate analysis with platelets< 105 /mm3 (P = .03), increased total bilirubin (P < .001), prolonged INR (P = .02), and albumin<3.5 g/dL (P = .03). CONCLUSIONS OBV/PTV/r+DSV+RBV proved to be highly efficient in our population of cirrhotics with a 96.6% SVR. Serious adverse events related to therapy were reported in 61/2070(2.9%), most of them liver decompensation (1.9%), related to hepatic dysfunction, and lower platelet count.
Collapse
Affiliation(s)
- Carmen M Preda
- UMF "Carol Davila" Gastroenterology & Hepatology Department, Clinic Fundeni Institute, Bucharest, Romania
| | - Corneliu P Popescu
- UMF "Carol Davila" Virology Department, Victor Babes Hospital, Bucharest, Romania
| | - Cristian Baicus
- UMF "Carol Davila" Internal Medicine Department, Colentina Hospital, Bucharest, Romania
| | - Theodor A Voiosu
- UMF "Carol Davila" Internal Medicine Department, Colentina Hospital, Bucharest, Romania
| | - Mircea Manuc
- UMF "Carol Davila" Gastroenterology & Hepatology Department, Clinic Fundeni Institute, Bucharest, Romania
| | - Corina Silvia Pop
- UMF "Carol Davila" Gastroenterology Department, Emergency Universitary Hospital, Bucharest, Romania
| | - Liana Gheorghe
- UMF "Carol Davila" Gastroenterology & Hepatology Department, Clinic Fundeni Institute, Bucharest, Romania
| | - Ioan Sporea
- UMF Timisoara, Gastroenterology & Hepatology Department, Timisoara Emergency Hospital, Timisoara, Romania
| | - Anca Trifan
- UMF Gr T Popa Iasi, Gastroenterology & Hepatology Department, Gastroenterology & Hepatology Institute, Iasi, Romania
| | - Marcel Tantau
- UMF I.Hatieganu Cluj, Gastroenterology & Hepatology Department, Medicala III, Cluj County Hospital, Cluj Napoca, Romania
| | - Alina Tantau
- UMF I.Hatieganu Cluj, Gastroenterology & Hepatology Department, Medicala III, Cluj County Hospital, Cluj Napoca, Romania
| | - Emanoil Ceausu
- UMF "Carol Davila" Virology Department, Victor Babes Hospital, Bucharest, Romania
| | - Doina Proca
- UMF "Carol Davila" Gastroenterology & Hepatology Department, Clinic Fundeni Institute, Bucharest, Romania
| | - Ileana Constantinescu
- UMF "Carol Davila" Gastroenterology & Hepatology Department, Clinic Fundeni Institute, Bucharest, Romania
| | - Simona M Ruta
- UMF "Carol Davila" Virology Department, Victor Babes Hospital, Bucharest, Romania
| | - Mircea M Diculescu
- UMF "Carol Davila" Gastroenterology & Hepatology Department, Clinic Fundeni Institute, Bucharest, Romania
| | - Alexandru Oproiu
- UMF "Carol Davila" Gastroenterology & Hepatology Department, Clinic Fundeni Institute, Bucharest, Romania
| |
Collapse
|
5
|
Network meta-analysis of first- and second-generation protease inhibitors for chronic hepatitis C genotype 1: efficacy based on RVR and SVR 24. Eur J Clin Pharmacol 2016; 73:1-14. [PMID: 27757504 DOI: 10.1007/s00228-016-2146-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2016] [Accepted: 10/07/2016] [Indexed: 12/17/2022]
Abstract
PURPOSE This study aimed to compare the efficacy among direct-acting antiviral agents (first and second-generation direct-acting antiviral agents (DAAs)) with placebo and with standard dual therapy (pegylated interferon + ribavirin (Peg-IFN + RBV)) in terms of rapid virologic response (RVR) and sustained virologic response (SVR) in chronic hepatitis C genotype 1 treatment. METHODS We performed a systematic review of randomized controlled trials (RCTs) in MEDLINE, International Pharmaceutical Abstracts, Cochrane Library, SCIELO, and Scopus and conducted a network meta-analysis to compare the efficacy of boceprevir (BOC), daclatasvir (DCV), grazoprevir, simeprevir (SMV) and telaprevir (TVR), in treatment-naive and treatment-experienced patients. RESULTS Sixteen studies encompassing 7171 patients were analysed. Associations between DAAs therapies (IFN-free regimens) could not be addressed since no common comparator was found in the RCTs among these associations and the other agents included in the present analysis. All agents were more efficacious than placebo or Peg-IFN + RBV in terms of RVR, while only BOC and SMV showed statistically significant superiority for the SVR outcome when compared to placebo or standard dual therapy. No significant differences between the DAAs were observed. The analysis prioritized treatment with DCV for both efficacy outcomes. Node-splitting analysis showed that our networks are robust (p > 0.05). CONCLUSIONS The superiority of DAAs over placebo or standard dual therapy with Peg-IFN + RBV was confirmed, indicating the greater efficacy of DCV. This study is the first network meta-analysis that included RVR as an outcome in the evaluation of these agents via indirect comparison. Further investigation should be carried out addressing safety and tolerability outcomes.
Collapse
|