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May 10, 2016

Hepatitis C Treatment Delivery Mandates Optimizing Available Health Care Human Resources: A Case for Task Shifting

Author Affiliations
  • 1Department of Transplantation, California Pacific Medical Center, San Francisco
  • 2Center for Innovation in Global Health, Stanford University, Stanford, California
  • 3Department of Internal Medicine, University of New Mexico Health Sciences Center, Albuquerque
  • 4Project ECHO, University of New Mexico, Albuquerque
  • 5Liver Transplant Program, Division of Gastroenterology and Hepatology, Stanford University Medical Center, Stanford, California
JAMA. 2016;315(18):1947-1948. doi:10.1001/jama.2016.1993

Recent data demonstrate the remarkable progress in efficacy, safety, tolerability, shortened treatment durations, and pangenotypic (one size fits all) reach of the next wave of direct-acting antivirals (DAAs) for chronic hepatitis C (HCV). Yet an inadequate treatment delivery workforce hampers HCV elimination efforts in both developed and developing countries.

Intense focus on the cost of DAAs has prompted novel cost-reduction strategies globally, including price reductions of proprietary (as opposed to generic) drugs, manufacturing licensed and unlicensed generics, and bulk purchasing. Treatment costs have declined substantially in some countries. For instance in Egypt, the country with the highest HCV prevalence, an ambitious national DAA-based treatment strategy is being planned following a 99% price discount by the company (relative to the US list price) that manufactures sofosbuvir. With several competing DAAs entering the market, prices of proprietary drugs will likely continue to decline.1 Shorter treatment courses also portend lower drug costs—early data suggest viability of 4- and 6-week regimens and even response-guided truncation of treatment after 3 weeks compared with the current 8 to 24 weeks. The imminent irrelevance of costly HCV genotyping and liver biopsy, and simplified laboratory monitoring schedules will further reduce demand for human, infrastructural, and financial resources. In addition, currently approved DAAs are already included in the World Health Organization’s Model List of Essential Medications, allowing these drugs to be justified for inclusion on national formularies and facilitating high-level drug price negotiations.