Reimbursement restrictions of DAAs for the treatment of Hepatitis C in Canada

Direct Acting Antivirals

CanHepC review shows more than 85% of Canadian provinces and territories restrict access to new direct-acting antivirals (DAA) for the treatment of the hepatitis C virus infection.

*Read the CRCHUM news brief on this article in french and English

Treatment with interferon-free, direct-acting antivirals (DAA) is effective in curing hepatitis C infection but the high cost of this medication present challenges for drug coverage of the estimated 220,000 hepatitis C infected persons in Canada.

A team of CanHepC researchers have conducted the first review in Canada examining publicly-funded, hepatitis C DAA reimbursement criteria for simeprevir, sofosbuvir, ledipasvir-sofosbuvir, and paritaprevir-ritonavir-ombitasvir plus dasabuvir. The review looked at reimbursement restrictions based on fibrosis stage, drug and alcohol use, HIV co-infection, and prescriber-type for all ten provinces and three territories.

Researchers found that depending on the hepatitis C DAA therapy, 85-92% of provinces-territories restricted therapy access to persons with moderate fibrosis (≥F2 METAVIR or equivalent). No drug and alcohol use restrictions were found. However, several criteria were left to the discretion of the physician. Quebec did not reimburse simeprevir and sofosbuvir for HIV co-infected persons with no restrictions found in the remaining jurisdictions. Prescriber-type was restricted to specialists-only in up to 42% of provinces-territories.

These study findings show considerable reimbursement heterogeneity by province-territory. To achieve World Health Organization HCV elimination targets by 2030, increased uptake of hepatitis C therapies, especially by people who inject drugs, will be essential to reduce hepatitis C incidence and contribute to viral elimination in Canada. Fibrosis stage restrictions are neither cost-effective nor evidence-based, and should be re-reviewed.

The authors conclude that the development and adoption of a national hepatitis C strategy in Canada, similar to Australia and Scotland, could facilitate volume-based discounting, reduce provincial-territorial heterogeneity, direct treatment to at-risk populations, and broaden equitable access.

Restrictions for reimbursement of direct-acting antiviral treatment for hepatitis C virus infection in Canada: a descriptive study. Alison D. Marshall, Sahar Saeed, Lisa Barrett, Curtis L. Cooper, Carla Treloar, Julie Bruneau, Jordan J. Feld, Lesley Gallagher, Marina B. Klein, Mel Krajden, Naglaa H. Shoukry, Lynn E. Taylor, Jason Grebely; the Canadian Network on Hepatitis C (CanHepC). CMAJ OPEN October 14, 2016 vol. 4no. 4 E605-E614. 

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*Photo credit : CHUM