Pricing of Hepatitis C Medicines in Canada: AHC Postition Statement

Posted on January 25, 2016 by - Uncategorized

Position Statement

Pricing of Hepatitis C Medicines in Canada

 Action Hepatitis Canada (AHC) is calling on the government of Canada to review and update legislative and regulatory frameworks involved in the establishment of pharmaceutical pricing in Canada.

The AHC is also calling for a re-evaluation of the prices that have been established for curative Hepatitis C (HCV) medicines that came to market beginning in 2014.

Background

The announcement of highly effective curative HCV treatments in 2014 – twenty-five years after the discovery of the hepatitis C virus – brought tremendous hope.  With these new therapies comes the possibility of eliminating this virus from our population, preventing needless suffering from end-stage liver disease and liver cancer, and saving lives.

Since that time, several other drugs have entered the market each with equally promising curative rates of approximately 95%[i].  These new medicines are taken daily for 8 to 12 weeks and have minimal side-effects.  In Canada, they have been priced at an average of $700 per pill[ii], making them unaffordable to most and causing many of our government bodies to limit financial coverage for treatment to people with advanced liver disease as a result of HCV[iii],[iv],[v].

Hepatitis C in Canada

HCV is a life-threatening virus that attacks the liver and can cause liver fibrosis, scarring of the liver (cirrhosis), liver cancer, and death from liver failure. As of 2011, approximately 250,000 Canadians were living with HCV, with thousands of new infections occurring every year[vi].

There is no vaccine for HCV, but it is curable.  Ideally, treatment is taken at earlier stages of illness, before the progression of liver damage and other symptoms of HCV.  Early treatment is recommended whenever possible as it contributes to improved quality of life and decreased health care costs[vii],[viii]. (See Action Hepatitis Canada: “Access to Hepatitis C Treatment”)

Patented Medicine Pricing in Canada

The current regulatory pricing system in Canada consistently sets drug prices among the highest in the world[ix],[x]. In the case of new HCV drugs, the prices have been set so high that governments and private payers cannot afford to treat all those who would benefit[xi],[xii],[xiii].

Pricing of patented medicines are regulated in Canada by the Patented Medicines Price Review Board (PMPRB).  The PMPRB determines the value of a medicine by looking at how well it works, the extent of negative side effects and the cost savings to the health system that the treatment will bring. Because of the largely curative nature of these new HCV treatments, the low degree of negative side effects and the cost to the health system of advanced HCV illness, the value of these new HCV medicines is high[xiv].  As a result, costs have been established at correspondingly high levels.

The pricing formula described above is used to set prices for ground-breaking new medicines typically developed to treat illnesses that affect a relatively small number of patients[xv], [xvi].

In those cases, treatment would have a strong value and be affordable for governments because of the small numbers of patients requiring treatment with those high-priced therapies.  However, this formula does not work for illnesses that are as prevalent as HCV – affecting about 1% of Canada’s population (more than 250,000 people)[xvii]. In cases of prevalent illness, a new pricing formula is required.

Inflated Pricing –Rationing of Treatment

As a result of high prices, many of Canada’s provinces and territories have placed restrictions on access to HCV treatments[xviii], limiting eligibility to people whose virus has progressed to cause significant fibrosis and damage to their liver.

These restrictive criteria are not supported by clinical evidence or by recommendations made by expert bodies in the field of Hepatology.  Bodies including the Canadian Association for the Study of the Liver[xix], the Canadian Agency for Drugs and Technology in Health[xx], the American Association for the Study of Liver Diseases[xxi], and the European Association for the Study of the Liver[xxii] each recommend that all patients be considered for treatment regardless of fibrosis level.

Ethical profit margins

Manufacturers of new HCV treatments are profiting at rates that are vastly disproportionate to their investment or to any reasonable expectation of commercial gain[xxiii],[xxiv],[xxv],[xxvi].  These companies have benefitted from a regulatory system in Canada that is outdated and in need of extensive critical examination and revision.

Legislative and regulatory processes in Canada should be re-designed to better ensure affordable pricing and broad accessibility of medicines while safeguarding an ethical profit margin for pharmaceutical companies.

If prices were set with ethical profit margins in mind, eligibility restrictions would be unnecessary, all people diagnosed with HCV could be treated regardless of fibrosis score, and corporate profits could be maintained within reasonable limits[xxvii],[xxviii].

Looking Forward – Systemic Change Required

It is essential that federal legislation and regulation be reviewed and updated in order to reduce the costs of essential medicines while continuing to ensure innovation and profit of pharmaceutical companies.

The AHC is calling on the Federal Government to take a stand on pharmaceutical pricing issues by establishing a regulatory process that strikes a better balance between encouraging development and investment while respecting the principle of equitable access within the Canadian healthcare system.

__________________________________________________

[i] RP Myers, H Shah, KW Burak, C Cooper, JJ Feld. An update on the management of chronic hepatitis C: 2015 consensus guidelines from the Canadian Association for the Study of the Liver. Can J Gastroenterol Hepatol 2015 In Press.

[ii] Canadian Treatment Action Council. Treatment Access Map. http://ctac.ca/resources/treatment-access-map.

[iii] CADTH Therapeutic Review. Drugs for Chronic Hepatitis C Infection: Recommendations Report. Version 1.0; November 2015.

[iv] Common Drug Review. CDEC Final Recommendation. Ledipasvir/Sofosbuvir (Harvoni – Gilead Sciences Canada, INC.). Accessed Dec 10, 2015 at https://www.cadth.ca/sites/default/files/cdr/complete/cdr_complete_SR0395_Harvoni_Mar_20-15.pdf

[v] Common Drug Review. CDEC Final Recommendation. Ombitasvir/Paritaprevir/Ritonavir and Dasabuvir (Holkira Pak – AbbVie Corporation). Accessed Dec 10, 2015 at https://www.cadth.ca/sites/default/files/cdr/complete/SR0406-Holkira-Pak-July-22-15-e.pdf

[vi] Trubnikov M, Yan P, Archibald C. Estimated Prevalence of Hepatitis C Virus infection in Canada, 2011. Canada Communicable Disease Report: Volume 40-19; December 18, 2014. Available at: http://www.phac-aspc.gc.ca/publicat/ccdr-rmtc/14vol40/dr-rm40-19/surveillance-b-eng.php.

[vii] Max Trubnikov, Ping Yan, Jane Njihia, Chris Archibald. Identifying and describing a cohort effect in the national database of reported cases of hepatitis C virus infection in Canada (1991-2010): an age-period-cohort analysis. CMAJ OPEN, 2(4).

[viii] Younossi ZM, Stepanova M, Henry L, et al. Effects of sofosbuvir-based treatment, with and without interferon, on outcome and productivity of patients with chronic hepatitis C. Clin Gastroenterol Hepatol. 2013.

[ix] Springer International Publishing Switzerland 2015 25 Z.-U.-D. Babar (ed.), Pharmaceutical Prices in the 21st Century;
Chapter 2: Drug Pricing in Canada DOI 10.1007/978-3-319-12169-7_2

[x] Marc-André Gagnon. A Roadmap to Rational Pharma-care Policy in Canada. Canadian Federation of Nurses Unions.

[xi]Jagpreet Chhatwal. Direct-Acting Antivirals for Hepatitis C Treatment: Effectiveness vs Cost-Effectiveness. Future Virology. 10.8 (Aug 2015): p929

[xii]S. Trooskin, H Reynolds, J. Kostman. Access to Costly New Hepatitis C Drugs: Medicine, Money, and Advocacy. Clinical Infectious Diseases; 2015;61(12):1825-30

[xiii] CADTH Therapeutic Review. Drugs for Chronic Hepatitis C Infection: Recommendations Report. Version 1.0; November 2015.

[xiv] Costly Cures. The Economist. June 2014.

[xv] Marc-André Gagnon. New Drug Pricing: Does it Make any Sense? Translated from Rev Prescrire. June 2015; 35 (380): 457-461.

[xvi] Troyen Brennan, William Shrank. New Expensive Treatments for Hepatitis Infection. Journal of the American Medical Association. Aug, 2014; vol. 312. Number 6.

[xvii] Troyen Brennan, William Shrank. New Expensive Treatments for Hepatitis Infection. Journal of the American Medical Association. Aug, 2014; vol. 312. Number 6

[xviii] Canadian Treatment Action Council. Treatment Access Map. http://ctac.ca/resources/treatment-access-map.

[xix] P Myers, H Shah, KW Burak, C Cooper, JJ Feld. An update on the management of chronic hepatitis C: 2015 consensus guidelines from the Canadian Association for the Study of the Liver. Can J Gastroenterology Hepatology; 2015 In Press.

[xx] CADTH Therapeutic Review. Drugs for Chronic Hepatitis C Infection: Recommendations Report. Version 1.0; November 2015.

[xxi] American Association for the Study of Liver Diseases. Recommendations for Testing, Managing, and Treating Hepatitis C. Accessed online October 1, 2015 at http://www.hcvguidelines.org/

[xxiii] Troyen Brennan, William Shrank. New Expensive Treatments for Hepatitis Infection. Journal of the American Medical Association. Aug, 2014; vol. 312. Number 6

[xxiv] S. Trooskin, H Reynolds, J. Kostman. Access to Costly New Hepatitis C Drugs: Medicine, Money, and Advocacy. Clinical Infectious Diseases; 2015;61(12):1825-30

[xxv] Wyden-Grassley Investigation finds Revenue-Driven Pricing Strategy Behind Gilead Hepatitis Drug. Accessed Dec 2015 at http://www.finance.senate.gov/newsroom/ranking/release/?id=3f693c73-0fc2-4a4c-ba92-562723ba5255

[xxvi] Kevin B Laupland MD MSc FRCPC, Louis Valiquette MD MSc FRCPC. The dollars and sense of chronic hepatitis C infection management. Canadian Journal of infectious Diseases and Medial Microbiology. Vol 26 No 3 May/June 2015

[xxvii] Jagpreet Chhatwal. Direct-Acting Antivirals for Hepatitis C Treatment: Effectiveness vs Cost-Effectiveness. Future Virology. 10.8 (Aug 2015): p929.

[xxviii] US Senate Committee on Veterans Affairs. Senate panel probes exorbitant prices for hepatitis C drugs. Washington, DC, 2014. Available at http://www.veterans.senate.gov/hearings/hepatitis-c-in-veterans. Accessed Dec 2015.

 

Download the PDF here.

Age-Cohort Testing: AHC Position Statement

Posted on December 22, 2015 by - Uncategorized

Action Hepatitis Canada is pleased to present the second of postition paper of 2015. Special thanks to our Policy Analyst Claire Checkland for her hard work, and to the Steering Committee for their input.

 

Position Statement

Hepatitis C Age Cohort Testing

Action Hepatitis Canada (AHC) calls for all adults born between 1945 and 1975 to be offered a one-time blood test for the hepatitis C virus (HCV).

Canada’s current screening guidelines recommend HCV testing for people with known risk factors for the infection including: people who use drugs; prisoners; those who were born, traveled or lived in a region with a high prevalence of HCV; people who received healthcare where there is a lack of universal precautions; and people who received blood or blood products in Canada prior to 1992.[1]  This risk-based approach to screening has had limited success as it relies heavily on memory and disclosure of past potential exposure to HCV.  Under this policy, it is estimated that nearly half of all cases of chronic HCV in Canada remain undiagnosed.[2]

The AHC believes that current risk-based screening recommendations need to be complemented with a recommendation for one-time screening for those born between the years of 1945 and 1975.

This recommendation has also been made by the Canadian Liver Foundation. One-time, voluntary age cohort testing for HCV is also recommended by the Centres for Disease Control and Prevention and Preventative Services Task Force in the United States of America.

 

Background and Evidence

Hepatitis C is a life-threatening virus that attacks the liver and can cause liver fibrosis or scarring, which may lead to cirrhosis and ultimately liver cancer or death from liver failure. As of 2011, at least 250,000 Canadians were living with HCV, with thousands of new infections occurring every year.[3]

In recent years, Canada has been facing an increase in the rates of people accessing healthcare with advanced cases of HCV infection.[4] Many of these people have been living with the virus for several decades and are now in need of extensive healthcare due to symptoms related to advanced liver disease including liver failure and liver cancer.[5]

More than 75% of chronic HCV infections in Canada are among people who were born between the years of 1945 and 1975[6] and it is estimated that at least 100,000 people living with chronic HCV infection are unaware that they are infected.[7]

Early Diagnosis and Access to Care

Recent advances in medicine mean that hepatitis C can be cured now in almost all cases in as little as 8 to 12 weeks.[8] These new treatments finally make the prospect of eliminating hepatitis C in Canada a real possibility.  In order to embrace this potential in Canada, it is necessary to significantly improve our rates of screening and diagnosis.

Treatment is less effective when hepatitis C is diagnosed and treated late.[9]  Late diagnosis also contributes to increased healthcare costs as a result of expensive treatment for liver failure and liver cancer such as liver transplantation.[10] Without improved rates of screening among people born between 1945-1975, the burden of infection and costs to our health and social systems will continue to increase as thousands of chronically infected individuals develop severe illness jeopardizing their capacity for employment and requiring extensive support from health and social assistance systems.[11], [12], [13], [14]

Targeted testing of this age cohort would facilitate the identification of chronic cases of HCV infection before the onset of severe symptoms. This would enable individuals to learn about the virus and its progression, ways to promote their own health, and about their options for treatment, care and support.

Awareness of individuals’ viral status is a crucial first step in the prevention of infection to others, the promotion of self-health and the eventual elimination of hepatitis C in Canada.

 

[1] Public Health Agency of Canada. Primary Care Management of Chronic Hepatitis C. Professional Desk Reference 2009. Accessed November 7, 2015 at www.phac-aspc.gc.ca.

[2] Trubnikov M, Yan P, Archibald C. Estimated Prevalence of Hepatitis C Virus infection in Canada, 2011. Canada Communicable Disease Report: Volume 40-19, December 18, 2014. Available at: http://www.phac-aspc.gc.ca/publicat/ccdr-rmtc/14vol40/dr-rm40-19/surveillance-b-eng.php

[3] Trubnikov M, Yan P, Archibald C. Estimated Prevalence of Hepatitis C Virus infection in Canada, 2011.

[4] Payne E, Totten S, Archibald C. Hepatitis C Surveillance in Canada. Canada Communicable Disease Report. December 18, 2014. Volume 40-19.

[5] American Association for the Study of Liver Disease. Baby Boomers Should get Tested for HCV. Accessed November 7, 2015 at www.aasld.org

[6] Remis RS. Modelling the incidence and prevalence of hepatitis C infection and its sequelae in Canada, 2007. Ottawa (ON): Public Health Agency of Canada; 2007

[7] Trubnikov M, Yan P, Archibald C. Estimated Prevalence of Hepatitis C Virus infection in Canada, 2011.

[8] RP Myers, H Shah, KW Burak, C Cooper, JJ Feld. An update on the management of chronic hepatitis C: 2015 consensus guidelines from the Canadian Association for the Study of the Liver. Can J Gastroenterol Hepatol 2015 In Press

[9] American Association for the Study of Liver Disease. Baby Boomers Should get Tested for HCV. Accessed November 7, 2015 at www.aasld.org

[10] Max Trubnikov, Ping Yan, Jane Njihia, Chris Archibald. Identifying and describing a cohort effect in the national database of reported cases of hepatitis C virus infection in Canada (1991-2010): an age-period-cohort analysis. CMAJ OPEN, 2(4).

[11] Max Trubnikov, Ping Yan, Jane Njihia, Chris Archibald. Identifying and describing a cohort effect… chronic cancer often nce in Canada. fection in Canada (1991-2010): an age-period-cohort analysis.CMAJthe national database of re

[12] William W.L. Wong PhD, Hong-Anh Tu PhD, Jordan J. Feld MD MPH, Tom Wong MD MPH, Murray Krahn MD MSc. Cost-effectiveness of screening for hepatitis C in Canada. Canadian Medical Association Journal. Published at www.cmaj.ca.

[13] American Association for the Study of Liver Diseases. Recommendations for Testing, Managing, and Treating Hepatitis C. Accessed online October 1, 2015 at http://www.hcvguidelines.org/

[14] Adriaan J van der Meer, MD; Bart J. Veldt, MD, PhD; Jordan J Feld, MD, PhD; et al. Association Between Sustained Virological Response and All-Cause Mortality Among Patients with Chronic Hepatitis C and Advanced Hepatic Fibrosis. JAMA. 2012; 308(24):2584-2593. Doi:10.1001/jama.2012.144878

 

Download the PDF here.

CADTH HCV Treatment Recommendations Released: In line with AHC feedback

Posted on December 11, 2015 by - Uncategorized

CADTH has released their updated recommendations for the treatment of Chronic Hepatitis C (CHC), following a request for feedback process in the summer. AHC submitted feedback in August that the current CADTH recommendations based on fibrosis levels were not evidence based, and urged CADTH to acknowledge a lack of clinical support to restricting access to medications to F2 or greater and make recommendations accordingly.

The new recommendation reads:

Recommendation 1: CDEC recommends that all patients with CHC infection should be considered for treatment, regardless of fibrosis score. Given the potential impact on health system sustainability of treating all patients with CHC infection on a first-come basis, priority for treatment should be given to patients with more severe disease.

AHC member patient groups CTAC, CLF, and Hep CBC are acknowledged as well. This is an excellent step towards better access to treatment, and gives advocacy groups even more leverage on this issue of eligibility criteria.

The full report can be read here.

Queen’s Park Breakfast: opportunities for leadership in Ontario

Posted on December 2, 2015 by - Uncategorized

AHC Legislature Breakfast

On Thursday, November 26th, Action Hepatitis Canada had the opportunity to host an education breakfast for MPPs at Queen’s Park in Toronto.

We welcome every opportunity to discuss policy solutions with decision-makers and this event was a great chance to raise awareness of the many policy alternatives that exist to eliminate hepatitis C from Canada. As Ontario bears the preponderance of the national burden, we took the opportunity to reiterate our call for leadership and direction in addressing hepatitis C as the most pressing public health issue in Ontario today.

Marsha

Attendees heard from Marsha Lecour, an advocate with lived experience, who shared her powerful story of living with – and being cured from – hepatitis C. Adam Cook, AHC Steering Committee member representing CTAC, followed. His slide deck is here, but in brief he spoke on the following points:

  • Hepatitis C is the most burdensome infectious disease in Canada, impacting more than just the liver.
  • Hepatitis C accounts for between 30-50% of all liver cancer in Canada; the only cancer whose mortality is increasing.
  • There is a cure for hepatitis C!
  • Present treatment rates are barely keeping pace with the rate of new infections in Canada.
  • Ontario bears at least one third of the national burden of hepatitis C.
  • One hepatitis C sufferer, if left untreated, will cost the Canadian health care system up to $330,000 in health costs. This is several times more than the cost of treatment.
  • There are many novel policy approaches! Quebec, Prince Edward Island, and New Brunswick have all modified their policies to increase access to treatment while controlling costs.
Adam at QP

Call to action for MPPs:

  • Tell your party’s Health Minister or Critic that you support increasing the hepatitis treatment rates in Ontario from 1.4% to 6%.
  • Consider getting testing for Hep C and inviting the media.
  • Write to Ontario’s Exceptional Access Program and ask how you can assist in enhancing the capacity and administrative resources to address Ontarians’ access to the cure for hepatitis C:

Rob Campbell
Ontario Public Drug Programs Division
Exceptional Access Program Branch
3rd Floor, 5700 Yonge St.
Toronto, ON M2M 4K5

Response from MPPs has been very good, and meetings have been had, or are scheduled, with MPP Yurek, PC Health Critic, and the Minister of Health’s office staff. Special thank you to MPP France Gélinas, NDP Health Critic, and her staff for being our sponsoring MPP for this event, and arranging tickets for Question Period, and to MPP Monique Taylor (NDP, Hamilton Mountain) who welcomed Adam and AHC to the house.

Queen’s Park Legislature Breakfast: Opportunities for an Improved Response to Hepatitis C in Ontario

Posted on November 23, 2015 by - Uncategorized

 

On Thursday, November 26, Action Hepatitis Canada is hosting an Education Breakfast at Queen’s Park to raise awareness about the issues around care for those affected by hepatitis C. Marsha Lecour of Toronto will share her experience living with hepatitis C, and Adam Cook of CTAC will present some models of care within Canada that can be used as a guide to help Ontario develop an improved response to hepatitis C, framed around the goal of elimination. To go along with this event, we have been able to secure a couple of meetings with MPPs and policy makers, so check back for updates on this exciting event!

Canada endorses the PAHO’s Action Plan for the Prevention and Control of Viral Hepatitis.

Posted on October 19, 2015 by - Uncategorized

The AHC recently reached out to Minister Ambrose to encourage her to endorse the Pan-American Health Organization’s Action Plan for the Prevention and Control of Viral Hepatitis, at the meeting of the General Assembly in Washington, DC from Sept 28-Oct 2.

Following the meeting, we received word from Gregory Taylor, Chief Public Health Officer, that Canada did indeed endorse the Plan of Action. The plan can be found here. It is a great step forward for Canada towards a strategy framed around the goal of elimination.

Access to Treatment: AHC Position Statement

Posted on October 12, 2015 by - Uncategorized

Action Hepatitis Canada is pleased to present the first of three position papers we plan to produce this fall. Special thanks to our Policy Analyst Claire Checkland for her hard work, and to the Executive Committee for their input.

Position Statement

Access to Hepatitis C Treatment

Action Hepatitis Canada (AHC) believes that Direct-Acting Antiviral (DAA) medications should be accessible to all Canadians who are living with chronic hepatitis C (HCV) regardless of their stage of disease progression.

Public reimbursement restrictions based either on fibrosis level or presence of cirrhosis should be eliminated.  Reimbursement policies should be based on clinical evidence, ensuring early access to treatment for all people living with HCV.

__________________

Background

HCV is a life-threatening virus that attacks the liver and can cause liver fibrosis, scarring of the liver (cirrhosis), liver cancer, and death from liver failure. As of 2011, approximately 250,000 Canadians were living with HCV, with thousands of new infections occurring every year[i].

Treatment

Prior to 2014, the standard treatment for HCV was a 24-48 week regimen of injections of pegylated interferon administered weekly combined with twice daily tablets of ribavirin. This therapy was associated with significant toxicity and side-effects and had a low cure rate (or Sustained Virologic Response) of 40%-50%[ii].

New treatments are now available. These new Direct-Acting Antiviral (DAA) medicines are highly tolerable, are taken for a shorter duration (as little as 8 to 12 weeks) and result in a cure rate of more than 90%.[iii]

Eligibility restrictions

Many provincial governments in Canada have placed strict restrictions on access to DAA treatments limiting eligibility for public reimbursement of treatment costs to people whose virus has progressed to cause significant fibrosis and damage to their liver.

These restrictive criteria are not based in best practice or medical evidence and are in opposition to recommendations made by expert bodies in the field of Hepatology including the Canadian Association for the Study of the Liver and the American Association for the Study of Liver Diseases.

Requiring the virus to progress to advanced liver disease before treatment denies early access to a cure and raises the risk of future medical complications caused by HCV[iv].

Benefits of treatment at time of diagnosis

There is an abundance of evidence demonstrating the benefits of treating HCV as early as possible before the development of severe liver disease or other preventable complications.

Early treatment results in:

  • a higher likelihood of successfully curing the virus through the attainment of a Sustained Virologic Response (SVR);[v]
  • the prevention of the development of liver disease and a decrease in liver inflammation[vi];
  • a reduction in liver-related conditions, including end-stage liver disease and liver cancer; [vii]
  • a reduction in the risk of liver-related mortality and liver transplantation;[viii]
  • a reduction in all-cause mortality[ix]
  • lesser likelihood of transmission of HCV to others;[x],[xi]
  • less required follow-up care;[xii]
  • substantial improvements to the quality of physical, emotional and social health.[xiii]

Without early treatment, the incidence of these complications[xiv] and the prevalence of chronic hepatitis C will increase significantly in the coming years[xv].

Eliminating Hepatitis C in Canada

HCV is curable. Early intervention and treatment is highly cost-effective and crucial to reducing morbidity and mortality levels.[xvi],[xvii]

Through appropriate testing, diagnosis and treatment, we now have both the opportunity and the ability to eliminate hepatitis C in Canada. The AHC calls on governments from all jurisdictions in Canada to embrace this opportunity.

 

 

[i] RTrubnikov M, Yan P, Archibald C. Estimated Prevalence of Hepatitis C Virus infection in Canada, 2011. Canada Communicable Disease Report: Volume 40-19, December 18, 2014. Available at: http://www.phac-aspc.gc.ca/publicat/ccdr-rmtc/14vol40/dr-rm40-19/surveillance-b-eng.php

[ii] RP Myers, H Shah, KW Burak, C Cooper, JJ Feld. An update on the management of chronic hepatitis C: 2015 consensus guidelines from the Canadian Association for the Study of the Liver. Can J Gastroenterol Hepatol 2015 In Press

[iii] Kevin B Laupland MD MSc FRCPC, Louis Valiquette MD MSc FRCPC. The dollars and sense of chronic hepatitis C infection management. Canadian Journal of infectious Diseases and Medial Microbiology. Vol 26 No 3 May/June 2015

[iv] Mikel Theobald. Dangers of Delaying Hepatitis C Treatment. Accessed September 15, 2015 at http://www.everydayhealth.com/news/dangers-delaying-hepatitis-c-treatment/

[v] American Association for the Study of Liver Diseases. Recommendations for Testing, Managing, and Treating Hepatitis C. Accessed online October 1, 2015 at http://www.hcvguidelines.org/

[vi] RP Myers, H Shah, et al. An update on the management of chronic hepatitis C

[vii] American Association for the Study of Liver Diseases. Recommendations for Testing, Managing, and Treating Hepatitis C. Accessed online October 1, 2015 at http://www.hcvguidelines.org/

[viii] Adriaan J van der Meer, MD; Bart J. Veldt, MD, PhD; Jordan J Feld, MD, PhD; et al. Association Between Sustained Virological Response and All-Cause Mortality Among Patients With Chronic Hepatitis C and Advanced Hepatic Fibrosis. JAMA. 2012; 308(24):2584-2593. Doi:10.1001/jama.2012.144878

[ix] American Association for the Study of Liver Diseases. Recommendations for Testing, Managing, and Treating Hepatitis C.

[x] RP Myers, H Shah, et al. An update on the management of chronic hepatitis C

[xi] C Zahnd, LP Salazar-Vizcaya, J-F Dufour, et al. (Swiss HIV and Hepatitis C Cohort Studies Team). Impact of Deferring HCV Treatment on Liver-Related events in HIV+ patients. 2015 Conference on Retroviruses and Opportunistic Infections. Seattle, February 23-24, 2015.

[xii] American Association for the Study of Liver Diseases. Recommendations for Testing, Managing, and Treating Hepatitis C.

[xiii] Younossi ZM, Stepanova M, Henry L, et al. Effects of sofosbuvir-based treatment, with and without interferon, on outcome and productivity of patients with chronic hepatitis C. Clin Gastroenterol Hepatol. 2013.

[xiv] C Zahnd, LP Salazar-Vizcaya, J-F Dufour, et al. (Swiss HIV and Hepatitis C Cohort Studies Team). Impact of Deferring HCV Treatment on Liver-Related events in HIV+ patients. 2015 Conference on Retroviruses and Opportunistic Infections. Seattle, February 23-24, 2015.

[xv] RP Myers, MD MSc; Mel Krajden, MD; Marc Bilodeau, MD; et al. Burden of disease and cost of chronic hepatitis C virus infection in Canada. Canadian Journal Gastroenterol Hepatol. 2014 May; 28(5): 243-250.

[xvi] Leidner AJ, Chesson HW, Xu F, Ward JW, Spradling PR, Holmberg SD. Cost-effectiveness of hepatitis C treatment for patients in early stages of liver disease. Hepatology. 2015;61:1860-9. [PMID: 25677072]

[xvii] David Rein, John Wittenborn, Bryce Smith, Danielle Liffman, John Ward. The Cost-effectiveness, Health Benefits, and Financial Cost of New Antiviral Treatments for Hepatitis C Virus. Clinical Infectious Diseases. 2015;61(2):157-68.

 

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AHC Urges Minister Ambrose to Endorse the WHO/PAHO Action Plan for the Prevention and Control of Viral Hepatitis

Posted on September 18, 2015 by - Uncategorized

This letter was sent today to Hon. Minister Ambrose, urging her, as Federal Minister of Health, to endorse the World Health Organization/Pan-American Health Organization Action Plan for the Prevention and Control of Viral Hepatitis, on behalf of the Government of Canada. The 67th Session of the Regional Committee of WHO for the Americas will be held in Washington, DC Sept 28-Oct 2 of this year, and the Action Plan will be presented.

Endorsement of this proposed Action Plan would be a great step forward for Canada towards a strategy framed around the goal of elimination, and at this time that endorsement seems unlikely. Feel free to use this letter as a template to urge the Minister on behalf of your own organization to strengthen this call to action!