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Improving access to the treatment of hepatitis C in low- and middle-income countries: evaluation of a patient assistance programme

Background Modern antiviral treatments have high cure rates against the hepatitis C virus however, the high cost associated with branded medicines and diagnostic tests, have resulted in poor access for many low-income patients residing in low-and-middle-income countries. Objective This study aimed t...

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Autores principales: Ali, Salamat, Ur-Rehman, Tofeeq, Ali, Mashhood, Haque, Sayeed, Rasheed, Faisal, Lougher, Eleri, Nawaz, Muhammad Sarfraz, Paudyal, Vibhu
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Springer International Publishing 2020
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8352841/
https://www.ncbi.nlm.nih.gov/pubmed/33247820
http://dx.doi.org/10.1007/s11096-020-01202-1
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author Ali, Salamat
Ur-Rehman, Tofeeq
Ali, Mashhood
Haque, Sayeed
Rasheed, Faisal
Lougher, Eleri
Nawaz, Muhammad Sarfraz
Paudyal, Vibhu
author_facet Ali, Salamat
Ur-Rehman, Tofeeq
Ali, Mashhood
Haque, Sayeed
Rasheed, Faisal
Lougher, Eleri
Nawaz, Muhammad Sarfraz
Paudyal, Vibhu
author_sort Ali, Salamat
collection PubMed
description Background Modern antiviral treatments have high cure rates against the hepatitis C virus however, the high cost associated with branded medicines and diagnostic tests, have resulted in poor access for many low-income patients residing in low-and-middle-income countries. Objective This study aimed to evaluate the role of a patient assistance programme and generic medicines in improving access to treatment of low-income hepatitis C patients in a low-and-middle-income country. Setting A major teaching public hospital in Islamabad, Pakistan. Methods Hepatitis C patients who presented and enrolled for the patient assistance programme during 12 months (1st July 2015 and 30th June 2016) were included. Demography, prescription characteristics, the total costs of Hepatitis C treatment, medicine cost supported by the programme, out-of-pocket cost borne by the patient and average cost effectiveness ratio per sustained virologic response were calculated and compared for different generic and branded regimens. Main outcome measure cost contribution of patient assistance programme. Results A total of 349 patients initiated the treatment through the programme and of those 334 (95.7%) completed the prescribed treatment. There were 294 (88.02%) patients who achieved sustained virologic response. Patient assistance programme contributed medicines cost averaging 60.28–86.26% of the total cost of treatment ($1634.6) per patient. The mean (SE) cost per patient for generic option (Sofosbuvir/Ribavirin) was the lowest [$658.36 (22.3) per patient, average cost effectiveness ratio = $720.1/SVR] than branded option (Sovaldi/Ribavirin) [$2218.66 (37.6) per patient, average cost effectiveness ratio = $2361.8/SVR] of the three available treatment regimens. From patients’ perspectives, the mean (SE) out-of-pocket cost was $296.9 (6.7) which primarily included diagnostic cost (69.9%) of the total cost. Conclusions Patient assistance programme, combined with generic brands of newer hepatitis C treatment offered a significant reduction in cost and widens access to hepatitis C treatment in low-and middle-income countries. However, substantial out-of-pocket costs of the treatment presents an important barrier for service access. There is a scope to widen such financial assistance programme to offer other costs attributed to patients, specifically for diagnosis, to widen service use in low-and-middle-income countries.
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spelling pubmed-83528412021-08-24 Improving access to the treatment of hepatitis C in low- and middle-income countries: evaluation of a patient assistance programme Ali, Salamat Ur-Rehman, Tofeeq Ali, Mashhood Haque, Sayeed Rasheed, Faisal Lougher, Eleri Nawaz, Muhammad Sarfraz Paudyal, Vibhu Int J Clin Pharm Research Article Background Modern antiviral treatments have high cure rates against the hepatitis C virus however, the high cost associated with branded medicines and diagnostic tests, have resulted in poor access for many low-income patients residing in low-and-middle-income countries. Objective This study aimed to evaluate the role of a patient assistance programme and generic medicines in improving access to treatment of low-income hepatitis C patients in a low-and-middle-income country. Setting A major teaching public hospital in Islamabad, Pakistan. Methods Hepatitis C patients who presented and enrolled for the patient assistance programme during 12 months (1st July 2015 and 30th June 2016) were included. Demography, prescription characteristics, the total costs of Hepatitis C treatment, medicine cost supported by the programme, out-of-pocket cost borne by the patient and average cost effectiveness ratio per sustained virologic response were calculated and compared for different generic and branded regimens. Main outcome measure cost contribution of patient assistance programme. Results A total of 349 patients initiated the treatment through the programme and of those 334 (95.7%) completed the prescribed treatment. There were 294 (88.02%) patients who achieved sustained virologic response. Patient assistance programme contributed medicines cost averaging 60.28–86.26% of the total cost of treatment ($1634.6) per patient. The mean (SE) cost per patient for generic option (Sofosbuvir/Ribavirin) was the lowest [$658.36 (22.3) per patient, average cost effectiveness ratio = $720.1/SVR] than branded option (Sovaldi/Ribavirin) [$2218.66 (37.6) per patient, average cost effectiveness ratio = $2361.8/SVR] of the three available treatment regimens. From patients’ perspectives, the mean (SE) out-of-pocket cost was $296.9 (6.7) which primarily included diagnostic cost (69.9%) of the total cost. Conclusions Patient assistance programme, combined with generic brands of newer hepatitis C treatment offered a significant reduction in cost and widens access to hepatitis C treatment in low-and middle-income countries. However, substantial out-of-pocket costs of the treatment presents an important barrier for service access. There is a scope to widen such financial assistance programme to offer other costs attributed to patients, specifically for diagnosis, to widen service use in low-and-middle-income countries. Springer International Publishing 2020-11-28 2021 /pmc/articles/PMC8352841/ /pubmed/33247820 http://dx.doi.org/10.1007/s11096-020-01202-1 Text en © The Author(s) 2020 https://creativecommons.org/licenses/by/4.0/Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/ (https://creativecommons.org/licenses/by/4.0/) .
spellingShingle Research Article
Ali, Salamat
Ur-Rehman, Tofeeq
Ali, Mashhood
Haque, Sayeed
Rasheed, Faisal
Lougher, Eleri
Nawaz, Muhammad Sarfraz
Paudyal, Vibhu
Improving access to the treatment of hepatitis C in low- and middle-income countries: evaluation of a patient assistance programme
title Improving access to the treatment of hepatitis C in low- and middle-income countries: evaluation of a patient assistance programme
title_full Improving access to the treatment of hepatitis C in low- and middle-income countries: evaluation of a patient assistance programme
title_fullStr Improving access to the treatment of hepatitis C in low- and middle-income countries: evaluation of a patient assistance programme
title_full_unstemmed Improving access to the treatment of hepatitis C in low- and middle-income countries: evaluation of a patient assistance programme
title_short Improving access to the treatment of hepatitis C in low- and middle-income countries: evaluation of a patient assistance programme
title_sort improving access to the treatment of hepatitis c in low- and middle-income countries: evaluation of a patient assistance programme
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8352841/
https://www.ncbi.nlm.nih.gov/pubmed/33247820
http://dx.doi.org/10.1007/s11096-020-01202-1
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