Incorporation of a DIRECT ACTING ANTIVIRAL treatment for HEPATITIS C in the Brazilian public health system

Abstract

Hepatitis C (HC) is a public health problem that affects 2% of the world population. Its chronification leads to chronic liver disease, cancer and advanced cirrhosis. In Brazil, HC prevalence ranges from 1% to 2% and free treatment is granted by the Unified National Health System (SUS). The direct acting antivirals (DAA) sofosbuvir, daclatasvir and simeprevir, recently made available in SUS, are considered a new promise towards HC virus (HCV) eradication. However, despite the greater DAA efficacy compared to previous drugs, their higher cost demands a continuous utilization assessment. The objective of this study was to characterize the utilization profile of DAA for HC treatment by SUS. Data from the Ambulatory Care Information System (SIA-SUS) were used. Between September 2015 and December 2016, 69,551 DAA dispensations occurred in SUS (45.2% for daclatasvir, 35.2% for sofosbuvir and 19.6% for simeprevir). There were differences in DAA utilization among the regions. Initially, sofosbuvir was the most frequently used DAA in the North (51.0%), Northeast (47.1%) and South (64%) regions, whilst daclatasvir was most used in the Center-West (55.9%) and Southeast (58.9%) regions. In 2016 the number of dispensations for sofosbuvir and daclatasvir became similar in Center-West region. Simeprevir was the least frequently used drug in all regions in both years. These differences in the DAA utilization could be justified by epidemiologic or clinical practice variations. Further studies are necessary to elucidate the factors implicated in those differences and their consequences in the quality of health assistance and resource allocation.