Viral hepatitis is a major public health problem throughout the world, killing more people every year than HIV.(i) Hepatitis C is a viral disease transmitted through infected bodily fluids and attacks the liver, slowly scarring the organ until the person acquires liver cancer or faces a number of other renal or hepatic conditions that diminish quality of life and eventually lead to liver transplant or death. Hepatitis C (HCV) affects 150 million people worldwide, with nearly 80 percent of those affected living in resource-limited countries.(ii) However, despite the high burden of disease, today most countries in the world are severely under-diagnosing and under-treating these populations. CHAI believes it is time to change that.
Hepatitis C: A New Era has Arrived
Until 2013, Hepatitis C treatment consisted of regular injections of pegylated interferon, a drug which caused painful side effects and was ineffective in more than half of cases. Furthermore, the treatment cost more than US$15,000 and required specialized care, limiting the ability of countries to set up effective and accessible public health programs. In fact, of the estimated 35 million people with cirrhosis requiring immediate treatment globally, fewer than 300,000 are being treated per year.(iii) Troublingly, many countries are approaching the point in their HCV epidemics where a peak number of people are now at the stage of cirrhosis, requiring treatment of their HCV and its comorbidities.
However, a watershed moment in Hepatitis C treatment occurred when the FDA approved Gilead’s Sofusbuvir in 2013, a new Direct-Acting Antiviral (DAA) oral pill with high cure rates, few side effects, and only requiring 12 to 24 weeks of treatment rather than the traditional one year. Since then, the pipeline of DAAs entering the market has grown, allowing doctors to achieve near perfect cure rates across genotypes through combinations of DAAs. Some innovator companies have quickly moved to provide access pricing and license generic manufacturers so the medicines can be available to the 90 million people in low- and middle-income countries that need it.(iv) In HIV, getting generic ARVs to market took eight years; for Hepatitis C, it may take only four years.
This rapid move to providing drugs at lower cost is a turning point, but on its own will not be enough to drive substantial patient access. The average cost of treating one patient is still between US$1,500 and US$2,000 today, which is a prohibitive price for many patients. Service delivery must be simplified and streamlined, with close consideration of which diagnostic and monitoring tests are necessary, and how hepatitis screening and treatment integrates into current health programs. This will help generate a competitive market for drugs and diagnostics, which will in turn support lower prices that country health budgets could absorb.
In April 2015, CHAI launched its viral hepatitis program, with a goal of getting patients on treatment with the right medicines at affordable prices. CHAI will be working in three to five countries to help partner governments design their hepatitis programs and answer questions like: how do we target screening strategies to find the most cases at the lowest cost? Which cadre of healthcare workers is capable of treating patients? What monitoring tests are critical? How many people can the government afford to treat? How can we use our existing infrastructure wisely?
While working closely with countries on determining how to implement programs successfully and sustainably, CHAI is also working with drug and diagnostic suppliers to ensure countries can benefit from a secure and safe supply of products at an affordable price.
The Future
With approximately 150 million people living with HVC and its devastating effects, there is no better time for countries to begin tackling their epidemics. The tools now exist to control—and one day even eliminate—this disease. What is required now is smart strategy on how to use them effectively so that countries can afford to act. This will require drugs and diagnostics to become more affordable, and for countries to think carefully yet ambitiously about how to integrate hepatitis screening and treatment into their public health systems. If governments, their partners, and the private sector come together to work on these two elements, countries could achieve the goal of affordable and accessible hepatitis treatment for those who need it
i Stanaway and Cooke et al. Global Burden of Disease Study 2013.
ii CHAI HCV Modelling, 2015.
iii Razavi et all, The Number of Treated HCV Infected Patients in Select Countries/Regions in 2004-2010. AASLD 2010.
iv CHAI HCV Modelling, 2015.
