The results of competitive bidding to procure medical drugs for hepatitis C treatment in adults and children will be announced within the next few days.
For the first time ever, this important function was delegated to the United Nations Development Program (UNDP), which will make innovative treatment of hepatitis C (HCV) more accessible to several thousand patients in Ukraine. It depends on the final price of drugs which will be defined in the contract.
The price for a standard HCV treatment course with original direct – acting antivirals (including sofosbuvir) in developed countries varies from 30 to 80 thousand US dollars, but Alliance for Public Health (hereinafter – Alliance) back in 2015 was able to procure sofosbuvir at the lowest price for the original drug – USD 900 per standard 12-week treatment course. This price became a reference point of the “upper price limit” for the current UNDP tender within 2015 state procurement!
According to the data presented by the World Health Organization (WHO) last year, over 185 million people in the world are infected with HCV, leading to 350 thousand deaths per year. Only in WHO European Region, 84 deaths per year are caused by hepatitis C-related cancer and cirrhosis.
In Ukraine, the epidemic of HCV is growing every year. The main independent infectious disease doctor of the Ministry of Health of Ukraine, Head of theInfectious Disease Department of the Bogomolets National Medical University, Professor Olha Holubovska makes an emphasis on the critical situation with HCV in the country: “According to WHO, in Ukraine over 5% of people are infected with hepatitis C, in absolute numbers it is more than 2 million people. In certain populations, the rate of infections is much higher. Thus, based on the data of the Monitoring and Disease Control Center of theMinistry of Health of Ukraine, the level of infections among people who often stay in hospitals is around 12%, and among patients of drug treatment clinics – up to 67%.”
Back in 2009, Alliance initiated large-scale HCV screening in vulnerable populations, and since 2011such testing is offered to general populationduring mass campaigns held within the all-Ukrainian “Demand Treatment!” advocacy campaign. In 2013, the Ukrainian Government approved the first National Targeted Program of HCV Prevention, Diagnostics and Treatment. However, the state allocates funding only for the treatment component, covering only 20% of the existing needs, while other important components of the program, including diagnostics, are not covered from the state budget at all. As a result, we have a vicious cycle: not many people may afford quality diagnostics, which is quite expensive, and as a result the statecannot make a reasonable estimate of the need in HCV treatment, plus it is not really interested in it… due to state budget limitations.
In 2015, Alliance initiated the first program to offer treatment with a new-generation drug – sofosbuvir – which is expected to reach 2,000patients.According to the results of the first stage of the program, in over 90% out of several dozens of patients who already received treatment HCV was not detected! Based on our treatment experience, at the end of the previous year amendments were introduced to the Unified Clinical Guidelines “ViralHepatitis C”, and the drug was included into the State Register of Medical Drugs and the national list of drugs which may be procured with budget funds. It will allow to provide treatment to hundreds thousands of patients.
“Based on the practical experience of Alliance in expanding access to HCV treatment, we found that civil society and international organizations canmake an important contribution to the response to the epidemic. For this purpose, we consistently join our efforts with all stakeholders, – underlinesLudmila Maistat, Senior Program Manager: Hepatitis, Alliance for Public Health. – We anticipate that at the next session of the World Health Assemblymember states will approve the first Global Health Sector Strategy for Viral Hepatitis, into the development of which Alliance has also contributed.Provided that there is sufficient funding, reduced prices for direct-acting antivirals, and access to quality generic drugs, Ukraine has a good chance to successfully implement this strategy and radically scale up access to innovative HCV treatment.”
Due to the critical underfunding of the national hepatitis program, the drugs which are planned to be procured with state budget funds will cover thereal needs only in part. Alliance was able to launch treatment with support of the international donors, but the amounts and the timeframes of suchfunding are also limited.
Alliance implements its programs in close cooperation with the Ministry of Health of Ukraine, having developed a joint vision of eliminating theepidemic in the country – including only modern drugs into treatment regimens, in particular quality generics, holding further negotiations withpharmaceutical companies, reducing prices for diagnostics and expanding the network of diagnostic centers, training of doctors and patients, and making a special focus on most vulnerable populations, with large-scale preventive activities among the general population – those are the comprehensive measures which will help to eliminate the HCV epidemic!
The experience of Georgia may be used as an example of efficient approach in the response to HCV epidemic. Government of the home country ofcurrent Ukrainian Minister of Health covers 70% of the cost of HCV treatment in most disadvantaged populations, with the remaining 30% provided by the municipal budgets. For other categories of patients, the state compensates 30% of the cost of treatment, with the remaining 70% allocated between the local budget and the patient, depending on the income of the latter. Such funding scheme functions like a certain social guarantee for low-income citizens. Free treatment of the members of vulnerable populations was defined as a paramount and top-priority task as this approach, according to WHO recommendations, is one of the key factors in making an impact on the epidemic. In Georgia, where the population is much smaller than inUkraine, the Government reached an agreement with the manufacturer on allocation of 20,000 HCV treatment courses and financial donations to improve the system of patient registration and effective medical support of the project.
The results of HCV screening held among over 4 thousands of those conscripted to the military forces, those involved into the military operations in theEast of Ukraine and demobilized soldiers, held by Alliance in 2015, demonstrated a rather high level of infections – about 4%, and in the main military hospitals – even up to 10%, which made the Ministry of Defense of Ukraine and mass media finally turned their attention to this burning issue.
In the time of military conflict in the East of our country and long-term economic crisis, we need to join our efforts in response to the epidemic. Sharp reduction in the cost of diagnostics and treatment with advanced drugs, their procurement at adequate prices (taking into account the price already achieved by Alliance in 2015) will become crucial and prominent steps on this way, which will prove the commitment of the state to care about the health of its citizens and will allow saving thousands of lives even in 2016!