PGI37 - UNIVERSAL ACCESS TO DIRECT-ACTING ANTIVIRALS FOR THE TREATMENT OF HEPATITIS C MANAGED BY THE HOSPITAL PHARMACY: CONTRIBUTIONS TO PUBLIC HEALTH AND PUBLIC EXPENDITURE

Universal access to direct-acting antivirals (DAA) for the treatment of hepatitis C virus (HCV) infection in Portugal is in place since February 2015. The aim of this study was to estimate the long-term effect of this policy for the population of patients monitored by Centro Hospitalar e Universitário de Coimbra (CHUC) until May 2018. Data on age, gender, metavir, genotype, risk behaviours, previous treatment experience and prescribed DAA were registered for all patients with central authorized treatment since February 2015. A discrete-time Markov model was used to estimate the lifetime impact of the new policy on mortality, morbidity and related costs. Mortality endpoints considered were life expectancy and liver-related death. Morbidity was expressed in terms of cirrhosis cases, hepatocellular carcinoma (HCC) and liver transplant (LT). Only direct costs incurred by the Portuguese NHS were calculated. A total of 1000 patients were included in this study. Average age of the population was 50.5 years and 76.9% were male. The majority of patients had genotype 1 HCV (65.3%), were treatment naïve (67.6%) and metavir F1 (35.6%). Regimens containing sofosbuvir accounted for 89.2% of the treatments. Treatment with DAA is expected to increase life expectancy by 6.4 years/patient, up to an average 28.8 years lived after treatment initiation. In the long run the burden of related liver disease can be decrease by 355 premature deaths, 549 cases of cirrhosis, 198 cases of HCC and 35 cases of LT. This would result into net public expenditure savings of 28.3 million euros, 23 million (82%) of which due to non-progression to advanced liver disease. Universal access to new generation direct-acting antivirals may contribute to a substantial reduction in the burden of hepatitis C and overwhelming reduction in Portuguese NHS expenditures to treat advanced liver disease.