Hepatitis C in the Brazilian Public Health Care System: Burden of Disease

Abstract

BACKGROUND: Infection by hepatitis C virus is one of the leading causes of chronic hepatitis C and cause severe burden for patients, families and the health care system. OBJECTIVE: The aims of this research were to assess the severity of liver fibrosis, comorbidities and complications of hepatitis C virus; to examine health-related quality of life (HRQoL), productivity loss and resource use and costs in a sample of Brazilian chronic hepatitis C, genotype 1, patients. METHODS: This was a cross-sectional multicenter study performed in genotype-1 chronic hepatitis C patients to assess disease burden in the Brazilian public health care system between November 2014 and March 2015. Patients were submitted to a liver transient elastography (FibroScan) to assess liver fibrosis and answered an interview composed by a questionnaire specifically developed for the study and three standardized questionnaires: EQ-5D-3L, HCV-PRO and WPAI:HepC. RESULTS: There were 313 subjects enrolled, with predominance of women (50.8%), caucasian/white (55.9%) and employed individuals (39.9%). Mean age was 56 (SD=10.4) years old. Moreover, 42.8% of patients who underwent FibroScan were cirrhotic; the most frequent comorbidity was cardiovascular disease (62.6%) and the most frequent complication was esophageal varices (54.5%). The results also showed that “pain and discomfort” was the most affected HRQoL dimension (55.0% of patients reported some problems) and that the mean HCV-PRO overall score was 69.1 (SD=24.2). Regarding productivity loss, the most affected WPAI:HepC component was daily activity (23.5%) and among employed patients, presenteeism was more frequent than absenteeism (18.5% vs 6.5%). The direct medical costs in this chronic hepatitis C sample was 12,305.72USD per patient in the 2 years study period; drug treatment costs represented 95.9% of this total. CONCLUSION: This study showed that most patients are cirrhotic, present high prevalence of cardiometabolic diseases and esophageal varices, reduced HRQoL mainly in terms of pain/discomfort, and work productivity impairment, especially presenteeism. Additionally, we demonstrated that hepatitis C virus imposes an economic burden on Brazilian Health Care System and that most of this cost is due to drug treatment.

Metabolic Evaluation in Patients With Hepatitis C Treated With Direct Antiviral Agents

“…The best form of segment for these patients who obtain SVR is still a topic that leaves a gap, due to the variability in the presentation of residual liver disease, both in the laboratory aspect and in imaging methods. In our study, the distribution of the degree of fibrosis among the patients evaluated before starting treatment was F0-F1 15.4%, F2 15.4%, F3 23.1%, and F4 46.2%, compared to a Brazilian study Castelo et al (54), involving 313 monitored in the public health system, where 42.8% of patients who underwent TE had cirrhosis. In ratification of our findings, in the study conducted by Loo et al (55) of the 411 patients evaluated at the beginning of treatment, 47.6% had basal fibrosis from F3 to F4.…”

A Real-life Study of the Positive Response to DAA-based Therapies for Hepatitis C in Brazil

“…Patients with genotypes 2 and 3 obtained the lowest SVR rates (92.2% and 90.6%, respectively) and were 1.5 and 2.8 more likely to not have SVR, respectively, when compared to genotype 1a and 1b, a finding that has been confirmed in other studies [19, 20, 21, 22, 23, 24, 25] .. Genotype 4 had an SVR of 97.6%, an excellent result, but the difference cannot be established as significant due to the small number of cases. Ferreira and collaborators evaluated 296 patients in the South region, obtaining SVR rates of 92% [16] . Another study including 1,002 patients treated for HCV, with genotypes 1, 2 and 3, also carried out in the South region by Holzmann et al, found that even patients with liver cirrhosis achieved SVR rates ranging from 88.5% to 100% [27] .In another study, in which 219 patients underwent therapy with DAAs, a high rate of SVR and excellent drug tolerability were found.…”

“…Another study including 1,002 patients treated for HCV, with genotypes 1, 2 and 3, also carried out in the South region by Holzmann et al, found that even patients with liver cirrhosis achieved SVR rates ranging from 88.5% to 100% [27] .In another study, in which 219 patients underwent therapy with DAAs, a high rate of SVR and excellent drug tolerability were found. Failure to achieve SVR was observed mainly among patients with at least one negative response predictor: cirrhosis and/or genotypes 2 or 3 [16] . Other studies carried out in the Southeast region yielded similar data [18,19,20, 21,29,30] .…”

“…SUS supported the annual cost per capita of US$ 6,152.85 on average for DAA-based therapies from 2015 to 2018 [14] . The Ministry of Health has developed a mathematical model to better understand the national prevalence data and establish its own elimination goals, including an estimation of the number of people to be treated [5,15].…”

“…The addition of Ribavirin allowed the achievement of sustained virologic response (SVR) rates of around 55%. The most important change occurred with the introduction of DAAs: shorter treatments, oral use, and general SVR rates above 95% [15] . The purpose of this study is to determine the impact of DAA regimens within all 27 Brazilian states and to identify the factors associated with SVR.…”