Direct-acting antivirals can be used from the early stages of hepatitis C infection. But patient follow-up should be organized.
They revolutionized the management of hepatitis C… But at what cost? Because of their high cost, the new direct-acting antivirals were reserved for the sickest patients. This will no longer be the case. This December 12, the High Authority of Health (HAS) confirms the announcements of the Ministry of Health: these drugs will now be accessible to anyone living with HCV.
A hefty bill
From the F0 or F1 fibrosis stage, patients will be eligible to obtain NAAD. With this recommendation, the HAS confirms the high efficiency of these molecules. In a cure of 8 to 12 weeks, the virus is eliminated from the body. The Authority nevertheless sets an essential point: before prescribing, the patient must be informed of the side effects and give his informed consent. Because if the disease has no symptoms, the side effects can be painful.
The second step is to reduce the price of the molecules, so that the cost-effectiveness ratio remains positive. Because 230,000 people in France are living with the virus. The cheapest NAAD cure is 28,700 euros. The bill is steep and it is not certain that the complications avoided (cirrhosis, liver cancer) are sufficient to balance the finances of the health insurance.
“The expansion of reimbursement for treatments to patients in the early stages of the disease will generate additional costs, which should be controlled by lowering prices to ensure efficiency at least equivalent to the treatment of patients in the most early stages of the disease. advanced ”, anticipates the HAS.
Optimize screening
The College, which publishes these recommendations, wants to ensure that this enlargement will be very useful. To this end, clinical follow-up will be required for any patient treated early. The data will make it possible to confirm the efficacy of drugs, verify their good tolerance and their impact on associated diseases.
Beyond treatment, it is also the screening strategy that must be reviewed, according to the HAS. It will soon be reassessed. Because treating is no longer enough. Transmission of the virus should also be avoided. In this regard, the failure is real: half of the carriers of the hepatitis C virus would ignore their status. “There is still a hidden epidemic of HCV infection,” said the Authority. Populations at risk must therefore be better identified. The arrival on the market of rapid diagnostic-oriented tests (TROD) could improve this.
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