Prevalence and Care for Hep C Varies Widely Across Continent

Marcia Frellick

October 25, 2015

BARCELONA, Spain — More than 8.5 million people in Europe have hepatitis C, but access to treatment — and prevalence of the disease — ranges widely from country to country.

"[It goes] from universal coverage in some countries to no access at all in others," said Markus Peck-Radosavljevic, MD, associate professor of medicine and vice-chairman at the Department of Gastroenterology and Hepatology at the Medical University of Vienna, Austria.

"In many countries, 2% or less of the infected patients are treated," he told attendees here at the 15th European AIDS Conference.

 
In many countries, 2% or less of the infected patients are treated. Dr Markus Peck-Radosavljevic
 

New direct-acting antiretrovirals have cure rates near 100%, are interferon free, and can be taken for shorter periods of time, but they can cost up to US$1000 a pill.

It has been difficult to get payers to cover treatments for everyone because only about 20% to 30% of people who have the virus develop a problem, Dr Peck-Radosavljevic explained, and there is no perfect way to predict who will develop significant disease, although noninvasive fibrosis measures have helped.

This uncertainty feeds a legitimate argument by some insurers, who question why they should pay for treating everyone if most will not develop serious disease, he said.

However, treating someone with significant fibrosis greatly improves the chance of survival and decreases the chance the patient will need a liver transplant or develop hepatocellular carcinoma.

Dr Peck-Radosavljevic said that World Health Organization guidelines for treating hepatitis C (he noted there are no European Union guidelines) call for reducing new infections by 50% by 2020 and by 70% by 2030, and reducing hepatitis C–related deaths by 60% by 2030.

More screening and prevention will be essential in hitting those targets, he said.

The incidence of hepatitis C infection in Europe ranges from 0.1% of the population in some countries to 8% in others.

Public Health England provides a good model in an area where incidence is very low, at 0.3% of the population, which is comparable to incidence in other countries, including Germany and Austria, he said.

About 90% of England's intravenous drug users are infected, however, and when you have a very high prevalence in a specific population, you know where to look, he added.

"It's more difficult to do that in Central Europe or Romania, which is a hot spot for viral hepatitis in Europe, where it's not only linked to intravenous drug use but where there's also a lot of nosocomial transmission, mostly through healthcare services, so almost everyone, essentially, can be affected," Dr Peck-Radosavljevic said.

Drug Costs Limit Access

As more varieties of the direct acting antiretrovirals become available, costs are starting to fall in parts of Europe, but this depends on the country.

Jean-Michel Molina, MD, professor of infectious diseases at the University of Paris Diderot in France, told Medscape Medical News that hepatitis C drug prices are still very high in France, and "only a little bit cheaper with the new AbbVie combination."

"They're not really coming down for us," he said.

"In some countries, a drug only becomes available after price negotiation, and that has been differently successful in various countries," Jürgen Rockstroh, MD, professor of medicine and head of the HIV Outpatient Clinic at the University of Bonn in Germany, told Medscape Medical News.

And price negotiation has left some countries on the sidelines.

"When you talk to the [European Union] commission, they will tell you that drug pricing and procurement is a member-state issue," Dr Peck-Radosavljevic said. So far, countries have not pulled together to negotiate a reasonable price because some countries have gotten really good deals and they do not want to give those up for the good of the union.

Tamás Bereczky, a leader in the treatment advocacy movement in Europe living who is living with HIV and hepatitis C, called pricing policies "opportunistic and nontransparent."

"Although there is a 'list price' announced," he said, "companies will agree with payers on a country-by-country basis on whatever they can. The prices are kept confidential, so we mostly rely on leaked information. This makes it very difficult to estimate if the prices have really come down or not."

Without drastically lower prices, Bereczky said, Europe will not be able to meet the World Health Organization goals.

"The introduction of generic medicines to this market is essential; otherwise, it will simply not be doable," he said.

Dr Molina has disclosed ties with Gilead, Merck, BMS, Tobira, ViiV, and Janssen. Dr Rockstroh has received speaking and/or consulting fees from Abbott, AbbVie, Bionor, BMS, Cipla, Gilead, Janssen, Merck, and ViiV. Dr Peck-Radosavljevic and Bereczky have disclosed no relevant financial relationships.

15th European AIDS Conference: Session PL4. Presented October 23, 2015.

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