OBJECTIVES: Novel treatments with direct-acting antivirals (DAAs) against Hepatitis C (HCV) address the issue of limited clinical efficacy with previous treatments at the individual and population level. However, the use of DAAs is accompanied by implications of affordability and equity in access to treatment. The present study aimed to identify a) real-world barriers to treatment access, as well as, b) criteria on potential pricing/negotiation decisions for DAAs from the physicians’ perspective in Greece, a country under financial constraints.

METHODS: A panel of physician experts in the management of HCV with geographical distribution representative of national clinical practice provided the primary data for the analysis. A two-step Delphi process was used to achieve consensus on the relative importance (scale 0-100) of a series of criteria on the two above-mentioned policy issues.

RESULTS: According to the Delphi process, the major barriers in access to treatment for Greek patients include patient ineligibility in meeting treatment criteria (restricted to F3 treatment experienced and F4 only) (90.0), limited patient awareness on the available treatments and their efficacy (58.8), lack of system capacity for the management of the disease (46.3) and lack of specialized medical personnel (26.8). Major criteria highlighted for pricing/negotiation process for DAAs were therapeutic efficacy of medicines (96.87), lack of alternative effective treatment (unmet need) (94.87), cost-effectiveness (93.37) and severity of the disease (91.62), followed by parameters such as safety, incidence of the disease etc.

CONCLUSIONS: According to physicians in Greece, main barriers to access to HCV treatment were strict criteria ineligibility, system capacity and patient awareness. With respect to the factors that should be taken into account during negotiations for DAAs, both economic and clinical criteria should be incorporated in the decision algorithm.