OBJECTIVES

In recent years, treatment for chronic hepatitis C has remarkably evolved, especially due to the introduction of new direct‐acting antivirals (DAAs). Interferon‐free DAA regimens have short durations, few adverse events, and higher efficacy. DAA agents sofosbuvir, daclatasvir, and simeprevir became available in the Brazilian national health system (SUS) in 2015 and are provided free of charge for all patients eligible for treatment. Their incorporation in SUS was possible thanks to an intense price negotiation with the producers. Initially, a total of 30,000 treatments were purchased by the Brazilian government in 2015 at an estimated cost of 400 million dollars. The purpose of this study was to assess the incorporation and utilization patterns of DAA drugs for the treatment of hepatitis C in Brazil from 2015 to 2017.

METHODS

Data were obtained from the SUS Ambulatory Information System which includes all records about patients using DAA. This is a freely available database maintained by the Brazilian government in which patient identity is preserved by encryption. Data manipulation and analysis were conducted using IBM SPSS Software version 22.

RESULTS

From 2015 to 2017, a total of 37,802 patients with hepatitis C were treated in Brazil. Patient access to treatment was concentrated in the south of Brazil (82% of the patients), where the wealthiest Brazilian States are located. Treatment coverage was markedly affected by the incorporation of new DAA. In 2015 only 20% of diagnosed patients were treated, though the treatment coverage rate was approximately 92% in 2014. This rate increased to 72% in 2017.

CONCLUSIONS

Despite the significant investment to improve the quality of care for patients with hepatitis C in Brazil, the incorporation of new DAA resulted in impaired access to therapy. It seems reasonable to assume that the high cost of new DAA could have contributed to that.