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Letter: self‐pay behaviour patients with chronic hepatitis C who required direct acting anti‐viral urgently in a real‐world setting

SIRS, We read with interest two recent articles by Lai et al. and Estes et al. regarding the treatment of hepatitis C virus (HCV) infection and its economic burden. With the advent of new direct acting anti-viral agents (DAAs) in non-Western countries, not only was there an improvement in sustained virological response (SVR) rates, but it is also possible to reduce total HCV-related healthcare expenditures. 2 Regulations under Named Patient Program (NPP) enable HCV-infected patients with an urgent need for treatments to access DAAs that have been approved outside of Taiwan. Nevertheless, there are still barriers to accessing these new therapies, especially when its high cost is taken into account. From October 2014 through October 2015, a total of 563 HCV-infected patients visited our clinics and we identified 99 subjects who urgently needed DAAs [including 66 peg-interferon/ribavirin (PR)-failure and 33 PR-ineligible patients]. For genotype (GT)-1b infections, treatment with 24 weeks of daclatasvir/asunaprevir (DCV/ASV, USD 30,000 per treatment course in Taiwan) was first considered. In addition, 12 weeks of ledipasvir/sofosbuvir (LDV/SOF, USD 71 000) was allowed for either GT-1a or -1b, and 12 weeks of SOF/ribavirin (USD 57 000) for GT-2. There were 70 patients infected with GT-1b and 29 infected with GT non-1b (GT-1a, n = 4; GT-2, n = 24; GT-6, n = 1). A total of 19 (19/99, 19.2%) patients finally paid for DAA treatments, including 16 DCV/ASV (all GT-1b), one LDV/SOF (GT-1b) and two SOF/ribavirin (GT-2a). As shown in Table 1, younger adults and GT-1b infected patients tended to favour self-pay medications, and there was no difference between PR-failure and PR-ineligible subjects. It is of no surprise that the majority of patients agreed to pay only USD 30 000 at most. After adjusting for age, GT-1b infection (odds ratio 8.629; 95% confidence interval = 1.482–50.243, P = 0.016) was still an independent factor associated with self-pay DAAs. We speculate that the acceptable pricing cap for selfpaid DAAs is less than USD 30,000 in Taiwan, and at least one-fifth of HCV-infected patients who urgently needed new treatments were satisfied with this price. So far, SVR after week 8 (9/9) and week 12 (7/7) were 100%.