| Summary: | In Canada it is estimated that 242,000 Canadians have chronic hepatitis C virus (HCV) infection; however, the exact number affected is unknown as 30% to 70% of patients are unaware that they are infected. Fifteen to 25% of patients with chronic infection will develop hepatocellular carcinoma, progressive liver disease, end-stage liver disease, or will require a liver transplant over 20 to 30 years of infection. There are six major HCV genotypes, and genotype 1 accounts for approximately 60% of HCV infections in Canadians. Since the early 2000s, the standard of care has been a combination of pegylated interferon alpha plus ribavirin (PR). The goal of treatment is viral eradication, defined as sustained virological response (SVR). Approximately 50% of patients with genotype 1 chronic hepatitis C (CHC) can expect to achieve SVR with PR therapy. Since 2011 four direct-acting antiviral agents (DAA) have been authorized to be used in combination with PR for the treatment of patients with genotype 1 CHC. Using triple therapy of DAA in combination with PR significantly increases SVR rates when compared with the use of PR alone. Patients receiving interferon may experience side effects such as fatigue, flu-like symptoms, psychiatric symptoms, seizures, weight loss, peripheral neuropathy, and bone marrow suppression. A number of novel DAA regimens, many of which do not include interferon, are currently under investigation and may be approved by Health Canada in the near future. Early evidence suggests that these treatments may offer better side effect profiles and higher cure rates, but may offer additional challenges in terms of affordability and accessibility. The purpose of this report is to provide evidence on the clinical effectiveness and cost-effectiveness of any interferon-free combination including at least one of the following drugs: boceprevir, telaprevir, simeprevir (SIM), or sofosbuvir (SOF)
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