OBJECTIVES: The availability of new direct-acting antivirals (DAAs) has radically changed the hepatitis C care scenario, leading to major efficacy results but creating a sustainability issue. Epidemiological studies report that in Sicily there are about 30,000 citizens with a diagnosis of chronic hepatitis due to HCV. The need to guarantee diagnostic and therapeutic appropriateness uniformity in the territory, in accordance with treatment priority criteria, and to provide easier access to healthcare, led to the creation of a Sicilian Network for the management of HCV.

METHODS: The HCV Network in Sicily consists of a web-based platform, which allows to manage the prescriptions and the delivery of DAA drugs for all resident HCV patients. The platform permits chronic hepatitis treatment control, cirrhosis and HCV post-transplant relapse and also allows to plan the clinical control of patients who do not have the criteria for treatment with DAAs. The network consists of 41 centers and 84 gastroenterologists or infectologists connected to each other through the web-based platform. The HCV Sicily Network database analysis allowed an assessment of treatment cost for each therapeutic regime. Furthermore, the correlation between the therapies administered, the results obtained, and the related adverse events was evaluated.

RESULTS: From May 2015 to December 2016, 11,317 patients have been recorded in the web platform and 5,931 patients started the treatment. The analysis showed that the HCV Network improves therapy management and allows a better assessment of clinical benefit. The data obtained from the Network also provided information on HCV epidemiology in Sicily and estimated the cost of treatments administered to patients. In addition, it showed antiretroviral therapy short term tolerability and efficacy data in a big patient cohort.

CONCLUSIONS: The Sicily HCV Network is an excellent monitoring system of patients with hepatitis C and an important tool to evaluate cost and consequence of treatment with DAAs.