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Marshall AD, Saeed S, Barrett L, Cooper CL, Treloar C, Bruneau J, Feld JJ, Gallagher L, Klein MB, Krajden M, Shoukry NH, Taylor LE, Grebely J. Restrictions for reimbursement of direct-acting antiviral treatment for hepatitis C virus infection in Canada: a descriptive study. CMAJ Open 2016; 4:E605-E614. [PMID: 28018873 PMCID: PMC5173474 DOI: 10.9778/cmajo.20160008] [Citation(s) in RCA: 62] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND In Canada, interferon-free, direct-acting antiviral hepatitis C virus (HCV) regimens are costly. This presents challenges for universal drug coverage of the estimated 220 000 people with chronic HCV infection nationwide. The study objective was to appraise criteria for reimbursement of 4 HCV direct-acting antivirals in Canada. METHODS We reviewed the reimbursement criteria for simeprevir, sofosbuvir, ledipasvir-sofosbuvir and paritaprevir-ritonavir-ombitasvir plus dasabuvir in the 10 provinces and 3 territories. Data were extracted from April 2015 to June 2016. The primary outcomes extracted from health ministerial websites were: 1) minimum fibrosis stage required, 2) drug and alcohol use restrictions, 3) HIV coinfection restrictions and 4) prescriber type restrictions. RESULTS Overall, 85%-92% of provinces/territories limited access to patients with moderate fibrosis (Meta-Analysis of Histologic Data in Viral Hepatitis stage F2 or greater, or equivalent). There were no drug and alcohol use restrictions; however, several criteria (e.g., active injection drug use) were left to the discretion of the physician. Quebec did not reimburse simeprevir and sofosbuvir for people coinfected with HIV; no restrictions were found in the remaining jurisdictions. Prescriber type was restricted to specialists in up to 42% of provinces/territories. INTERPRETATION This review of criteria of reimbursement of HCV direct-acting antivirals in Canada showed substantial interjurisdictional heterogeneity. The findings could inform health policy and support the development and adoption of a national HCV strategy.
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Affiliation(s)
- Alison D Marshall
- The Kirby Institute (Marshall, Grebely), UNSW Australia, Sydney, Australia; Department of Epidemiology, Biostatistics and Occupational Health (Saeed), McGill University, Montréal, Que.; Faculty of Medicine (Klein), McGill University, Montréal, Que.; Faculty of Medicine (Barrett), Dalhousie University, Halifax, NS; Department of Medicine (Cooper), University of Ottawa, Ottawa, Ont.; Centre for Social Research in Health (Treloar), UNSW Australia, Sydney, Australia; Centre de recherche du Centre hospitalier de l'Université de Montréal (Bruneau, Shoukry), Montréal, Que.; Liver Centre (Feld), Toronto Western Hospital, University Health Network/University of Toronto, Toronto, Ont.; Vancouver Coastal Health (Gallagher); BC Centre for Disease Control (Krajden), Vancouver, BC; Department of Medicine (Taylor), Brown University, Providence, RI
| | - Sahar Saeed
- The Kirby Institute (Marshall, Grebely), UNSW Australia, Sydney, Australia; Department of Epidemiology, Biostatistics and Occupational Health (Saeed), McGill University, Montréal, Que.; Faculty of Medicine (Klein), McGill University, Montréal, Que.; Faculty of Medicine (Barrett), Dalhousie University, Halifax, NS; Department of Medicine (Cooper), University of Ottawa, Ottawa, Ont.; Centre for Social Research in Health (Treloar), UNSW Australia, Sydney, Australia; Centre de recherche du Centre hospitalier de l'Université de Montréal (Bruneau, Shoukry), Montréal, Que.; Liver Centre (Feld), Toronto Western Hospital, University Health Network/University of Toronto, Toronto, Ont.; Vancouver Coastal Health (Gallagher); BC Centre for Disease Control (Krajden), Vancouver, BC; Department of Medicine (Taylor), Brown University, Providence, RI
| | - Lisa Barrett
- The Kirby Institute (Marshall, Grebely), UNSW Australia, Sydney, Australia; Department of Epidemiology, Biostatistics and Occupational Health (Saeed), McGill University, Montréal, Que.; Faculty of Medicine (Klein), McGill University, Montréal, Que.; Faculty of Medicine (Barrett), Dalhousie University, Halifax, NS; Department of Medicine (Cooper), University of Ottawa, Ottawa, Ont.; Centre for Social Research in Health (Treloar), UNSW Australia, Sydney, Australia; Centre de recherche du Centre hospitalier de l'Université de Montréal (Bruneau, Shoukry), Montréal, Que.; Liver Centre (Feld), Toronto Western Hospital, University Health Network/University of Toronto, Toronto, Ont.; Vancouver Coastal Health (Gallagher); BC Centre for Disease Control (Krajden), Vancouver, BC; Department of Medicine (Taylor), Brown University, Providence, RI
| | - Curtis L Cooper
- The Kirby Institute (Marshall, Grebely), UNSW Australia, Sydney, Australia; Department of Epidemiology, Biostatistics and Occupational Health (Saeed), McGill University, Montréal, Que.; Faculty of Medicine (Klein), McGill University, Montréal, Que.; Faculty of Medicine (Barrett), Dalhousie University, Halifax, NS; Department of Medicine (Cooper), University of Ottawa, Ottawa, Ont.; Centre for Social Research in Health (Treloar), UNSW Australia, Sydney, Australia; Centre de recherche du Centre hospitalier de l'Université de Montréal (Bruneau, Shoukry), Montréal, Que.; Liver Centre (Feld), Toronto Western Hospital, University Health Network/University of Toronto, Toronto, Ont.; Vancouver Coastal Health (Gallagher); BC Centre for Disease Control (Krajden), Vancouver, BC; Department of Medicine (Taylor), Brown University, Providence, RI
| | - Carla Treloar
- The Kirby Institute (Marshall, Grebely), UNSW Australia, Sydney, Australia; Department of Epidemiology, Biostatistics and Occupational Health (Saeed), McGill University, Montréal, Que.; Faculty of Medicine (Klein), McGill University, Montréal, Que.; Faculty of Medicine (Barrett), Dalhousie University, Halifax, NS; Department of Medicine (Cooper), University of Ottawa, Ottawa, Ont.; Centre for Social Research in Health (Treloar), UNSW Australia, Sydney, Australia; Centre de recherche du Centre hospitalier de l'Université de Montréal (Bruneau, Shoukry), Montréal, Que.; Liver Centre (Feld), Toronto Western Hospital, University Health Network/University of Toronto, Toronto, Ont.; Vancouver Coastal Health (Gallagher); BC Centre for Disease Control (Krajden), Vancouver, BC; Department of Medicine (Taylor), Brown University, Providence, RI
| | - Julie Bruneau
- The Kirby Institute (Marshall, Grebely), UNSW Australia, Sydney, Australia; Department of Epidemiology, Biostatistics and Occupational Health (Saeed), McGill University, Montréal, Que.; Faculty of Medicine (Klein), McGill University, Montréal, Que.; Faculty of Medicine (Barrett), Dalhousie University, Halifax, NS; Department of Medicine (Cooper), University of Ottawa, Ottawa, Ont.; Centre for Social Research in Health (Treloar), UNSW Australia, Sydney, Australia; Centre de recherche du Centre hospitalier de l'Université de Montréal (Bruneau, Shoukry), Montréal, Que.; Liver Centre (Feld), Toronto Western Hospital, University Health Network/University of Toronto, Toronto, Ont.; Vancouver Coastal Health (Gallagher); BC Centre for Disease Control (Krajden), Vancouver, BC; Department of Medicine (Taylor), Brown University, Providence, RI
| | - Jordan J Feld
- The Kirby Institute (Marshall, Grebely), UNSW Australia, Sydney, Australia; Department of Epidemiology, Biostatistics and Occupational Health (Saeed), McGill University, Montréal, Que.; Faculty of Medicine (Klein), McGill University, Montréal, Que.; Faculty of Medicine (Barrett), Dalhousie University, Halifax, NS; Department of Medicine (Cooper), University of Ottawa, Ottawa, Ont.; Centre for Social Research in Health (Treloar), UNSW Australia, Sydney, Australia; Centre de recherche du Centre hospitalier de l'Université de Montréal (Bruneau, Shoukry), Montréal, Que.; Liver Centre (Feld), Toronto Western Hospital, University Health Network/University of Toronto, Toronto, Ont.; Vancouver Coastal Health (Gallagher); BC Centre for Disease Control (Krajden), Vancouver, BC; Department of Medicine (Taylor), Brown University, Providence, RI
| | - Lesley Gallagher
- The Kirby Institute (Marshall, Grebely), UNSW Australia, Sydney, Australia; Department of Epidemiology, Biostatistics and Occupational Health (Saeed), McGill University, Montréal, Que.; Faculty of Medicine (Klein), McGill University, Montréal, Que.; Faculty of Medicine (Barrett), Dalhousie University, Halifax, NS; Department of Medicine (Cooper), University of Ottawa, Ottawa, Ont.; Centre for Social Research in Health (Treloar), UNSW Australia, Sydney, Australia; Centre de recherche du Centre hospitalier de l'Université de Montréal (Bruneau, Shoukry), Montréal, Que.; Liver Centre (Feld), Toronto Western Hospital, University Health Network/University of Toronto, Toronto, Ont.; Vancouver Coastal Health (Gallagher); BC Centre for Disease Control (Krajden), Vancouver, BC; Department of Medicine (Taylor), Brown University, Providence, RI
| | - Marina B Klein
- The Kirby Institute (Marshall, Grebely), UNSW Australia, Sydney, Australia; Department of Epidemiology, Biostatistics and Occupational Health (Saeed), McGill University, Montréal, Que.; Faculty of Medicine (Klein), McGill University, Montréal, Que.; Faculty of Medicine (Barrett), Dalhousie University, Halifax, NS; Department of Medicine (Cooper), University of Ottawa, Ottawa, Ont.; Centre for Social Research in Health (Treloar), UNSW Australia, Sydney, Australia; Centre de recherche du Centre hospitalier de l'Université de Montréal (Bruneau, Shoukry), Montréal, Que.; Liver Centre (Feld), Toronto Western Hospital, University Health Network/University of Toronto, Toronto, Ont.; Vancouver Coastal Health (Gallagher); BC Centre for Disease Control (Krajden), Vancouver, BC; Department of Medicine (Taylor), Brown University, Providence, RI
| | - Mel Krajden
- The Kirby Institute (Marshall, Grebely), UNSW Australia, Sydney, Australia; Department of Epidemiology, Biostatistics and Occupational Health (Saeed), McGill University, Montréal, Que.; Faculty of Medicine (Klein), McGill University, Montréal, Que.; Faculty of Medicine (Barrett), Dalhousie University, Halifax, NS; Department of Medicine (Cooper), University of Ottawa, Ottawa, Ont.; Centre for Social Research in Health (Treloar), UNSW Australia, Sydney, Australia; Centre de recherche du Centre hospitalier de l'Université de Montréal (Bruneau, Shoukry), Montréal, Que.; Liver Centre (Feld), Toronto Western Hospital, University Health Network/University of Toronto, Toronto, Ont.; Vancouver Coastal Health (Gallagher); BC Centre for Disease Control (Krajden), Vancouver, BC; Department of Medicine (Taylor), Brown University, Providence, RI
| | - Naglaa H Shoukry
- The Kirby Institute (Marshall, Grebely), UNSW Australia, Sydney, Australia; Department of Epidemiology, Biostatistics and Occupational Health (Saeed), McGill University, Montréal, Que.; Faculty of Medicine (Klein), McGill University, Montréal, Que.; Faculty of Medicine (Barrett), Dalhousie University, Halifax, NS; Department of Medicine (Cooper), University of Ottawa, Ottawa, Ont.; Centre for Social Research in Health (Treloar), UNSW Australia, Sydney, Australia; Centre de recherche du Centre hospitalier de l'Université de Montréal (Bruneau, Shoukry), Montréal, Que.; Liver Centre (Feld), Toronto Western Hospital, University Health Network/University of Toronto, Toronto, Ont.; Vancouver Coastal Health (Gallagher); BC Centre for Disease Control (Krajden), Vancouver, BC; Department of Medicine (Taylor), Brown University, Providence, RI
| | - Lynn E Taylor
- The Kirby Institute (Marshall, Grebely), UNSW Australia, Sydney, Australia; Department of Epidemiology, Biostatistics and Occupational Health (Saeed), McGill University, Montréal, Que.; Faculty of Medicine (Klein), McGill University, Montréal, Que.; Faculty of Medicine (Barrett), Dalhousie University, Halifax, NS; Department of Medicine (Cooper), University of Ottawa, Ottawa, Ont.; Centre for Social Research in Health (Treloar), UNSW Australia, Sydney, Australia; Centre de recherche du Centre hospitalier de l'Université de Montréal (Bruneau, Shoukry), Montréal, Que.; Liver Centre (Feld), Toronto Western Hospital, University Health Network/University of Toronto, Toronto, Ont.; Vancouver Coastal Health (Gallagher); BC Centre for Disease Control (Krajden), Vancouver, BC; Department of Medicine (Taylor), Brown University, Providence, RI
| | - Jason Grebely
- The Kirby Institute (Marshall, Grebely), UNSW Australia, Sydney, Australia; Department of Epidemiology, Biostatistics and Occupational Health (Saeed), McGill University, Montréal, Que.; Faculty of Medicine (Klein), McGill University, Montréal, Que.; Faculty of Medicine (Barrett), Dalhousie University, Halifax, NS; Department of Medicine (Cooper), University of Ottawa, Ottawa, Ont.; Centre for Social Research in Health (Treloar), UNSW Australia, Sydney, Australia; Centre de recherche du Centre hospitalier de l'Université de Montréal (Bruneau, Shoukry), Montréal, Que.; Liver Centre (Feld), Toronto Western Hospital, University Health Network/University of Toronto, Toronto, Ont.; Vancouver Coastal Health (Gallagher); BC Centre for Disease Control (Krajden), Vancouver, BC; Department of Medicine (Taylor), Brown University, Providence, RI
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