OBJECTIVES

: The hepatitis C virus (HCV) is a disease of global importance, affecting between 80-180 million people globally. Since 2013, Direct-acting Antiviral Agents (DAAs) have revolutionised treatment, transforming it to a readily curable condition. In response, the World Health Organization has announced a global strategy of eliminating HCV as a threat to public health by 2030. Consequently, in 2016 the Australian Government provided AUD1 billion in funding over five years to subsidise these drugs. The aim of this paper was to quantify the government costs associated with this initiative.

METHODS

: A retrospective analysis of Medicare expenditure data was undertaken for March 2016 to December 2018. Expenditure data were extracted for all DAAs from the Medicare Statistical Reports website.

RESULTS

: In the first 22 months of this initiative, an estimated AUD4.4 billion was expended – far exceeding the AUD1 billion over five years. However, due to confidential Special Pricing Agreements between pharmaceutical companies and Government, a precise figure can not be calculated. Reported expenditure was highest for Harvoni (Ledipasvir + Sofosbuvir) at AUD1.7 billion and Sovaldi (Sofosbuvir) at AUD1.5 billion.

CONCLUSIONS

: Whilst reimbursement of DAAs to all patients irrespective of comorbidity or risk practices represents an excellent public health initiative, the lack of transparency precludes a robust assessment of the impact this has had on government expenditure. Ensuring a balance between society’s (i.e. taxpayers) interests and those of pharmaceutical companies requires careful consideration, as in this example, these confidential pricing agreements do not allow for objective assessments of whether this policy represents good value for money.