The direct-medical costs associated with interferon-based treatment for Hepatitis C in Vietnam

Abstract

Background: Injectable interferon-based therapies have been used to treat hepatitis C virus (HCV) infection since 1991. International guidelines have now moved away from interferon-based therapy towards direct-acting antiviral (DAA) tablet regimens, because of their superior efficacy, excellent side-effect profiles, and ease of administration. Initially DAA drugs were prohibitively expensive for most healthcare systems. Access is now improving through the procurement of low-cost, generic DAAs acquired through voluntary licenses. However, HCV treatment costs vary widely, and many countries are struggling with DAA treatment scale-up. This is not helped by the limited cost data and economic evaluations from low- and middle-income countries to support HCV policy decisions. We conducted a detailed analysis of the costs of treating chronic HCV infection with interferon-based therapy in Vietnam. Understanding these costs is important for performing necessary economic evaluations of novel treatment strategies. Methods: We conducted an analysis of the direct medical costs of treating HCV infection with interferon alpha (IFN) and pegylated-interferon alpha (Peg-IFN), in combination with ribavirin, from the health sector perspective at the Hospital for Tropical Diseases, Ho Chi Minh City, Vietnam, in 2017. Results: The total cost of the IFN treatment regimen was estimated to range between US$1,120 and US$1,962. The total cost of the Peg-IFN treatment regimen was between US$2,156 and US$5,887. Drug expenses were the biggest contributor to the total treatment cost (54-89%) and were much higher for the Peg-IFN regimen. Conclusions: We found that treating HCV with IFN or Peg-IFN resulted in significant direct medical costs. Of concern, we found that all patients incurred substantial out-of-pocket costs, including those receiving the maximum level of support from the national health insurance programme. This cost data highlights the potential savings and importance of increased access to generic DAAs in low- and middle-income countries and will be useful within future economic evaluations.

A stem-loop RNA RIG-I agonist protects against acute and chronic SARS-CoV-2 infection in mice

“…In a retrospective multicenter cohort study of 446 COVID-19 patients, early administration of inhaled IFNα2b produced more favorable clinical responses compared with lopinavir/ritonavir treatment alone and was associated with reduced in-hospital mortality ( Wang et al, 2020 ). While results from rIFN-based clinical trials are promising, one of the major disadvantages of this approach is its high cost, with direct medical costs ranging between $1,120 and $1,962 for the IFN treatment regimen and $2,156 and $5,887 for the PEG-IFN treatment regimen ( Nguyen et al, 2020 ). In addition, administration of rIFN has been shown to induce neutralizing antibody response against IFN that could render the therapy ineffective ( Giovannoni et al, 2002 ; Matsuda et al, 2012 ).…”

“…Growing evidence suggests that recombinant IFN (rIFN)–based intervention during the early stage of COVID-19 could provide desired clinical benefits in humans. However, rIFN therapy is costly ( Nguyen et al, 2020 ) and can be rendered ineffective by the induction of binding and/or neutralizing anti-drug antibodies ( Giovannoni et al, 2002 ; Matsuda et al, 2012 ). In contrast, SLR14 is highly manufacturable and can elicit a broad and diverse IFN response.…”

Interferon Treatments for SARS-CoV-2: Challenges and Opportunities

“…The cost of IFN, adherence and accessibility must be considered in scaling up IFN therapy to treat SARS-CoV-2. In Vietnam and Brazil, the weekly cost to treat hepatitis C virus (HCV) with IFN therapy ranged from $25.32 to $109.07 USD, depending on the subtype of interferon used [ 28 , 29 ]. While IFN therapy regimens for SARS-COV-2 are shorter (4 weeks compared to 24–48 weeks), cost may remain a barrier to scale-up [ 29 ].…”

“…In Vietnam and Brazil, the weekly cost to treat hepatitis C virus (HCV) with IFN therapy ranged from $25.32 to $109.07 USD, depending on the subtype of interferon used [ 28 , 29 ]. While IFN therapy regimens for SARS-COV-2 are shorter (4 weeks compared to 24–48 weeks), cost may remain a barrier to scale-up [ 29 ]. IFN therapy is most effective during the early stages of SARS-CoV-2 infection, which may further reduce costs associated with long recovery times.…”

A stem-loop RNA RIG-I agonist confers prophylactic and therapeutic protection against acute and chronic SARS-CoV-2 infection in mice

“…In a retrospective multicenter cohort study of 446 COVID-19 patients, early administration of inhaled IFNα2b produced more favorable clinical responses compared to lopinavir/ritonavir (LPV/r) treatment alone and was associated with reduced in-hospital mortality 41 . While results from recombinant IFN-based clinical trials are promising, one of the major disadvantages of this approach is its high cost, with the direct medical cost of IFN treatment regimen to range between $1,120 and $1,962 and PEG-IFN treatment regimen between $2,156 and $5,887 42 . In addition, administration of recombinant IFN has been shown to induce neutralizing antibody response that could render the therapy ineffective 43 .…”