PDG13 CURRENT PRESCRIPTION PROFILE OF RIBAVIRIN FOR HEPATITIS C IN BRAZIL AND THE BUDGET IMPACT ANALYSIS ON UPDATED RECOMMENDATIONS FOR ITS USE BETWEEN 2020 AND 2024 IN THE BRAZILIAN PUBLIC HEALTH SYSTEM

Abstract

The National Hepatitis C Elimination Program (NHCEP) launched in 2017 aims to treat 50,000 people/year by 2024. The high effectiveness rate of direct-acting antivirals (DAA) allows ribavirin-free therapies for most patients with no disadvantage to therapeutic success, reducing adverse events. Previously, the Brazilian Ministry of Health (MS) allowed the use of Ribavirin the discretion of the physician, but from January 2020 its use is no longer allowed in patients without cirrhosis and on initial treatment. This study aims to evaluate the ribavirin prescription profile in Brazil before 2020 and to measure the budgetary impact on the updated recommendation for its use in the Brazilian Public Health System (SUS). A retrospective analysis of hepatitis C treatment requests sent to the MS between June and December 2019 was performed. Patients were classified according to i) presence of cirrhosis; ii) initial treatment and retreatment; and iii) quantity’s ribavirin used. The budgetary impact calculation considered the most recent purchase price of USD 0.5 per capsule. During the period analyzed, 27,371 initial treatments were requested, 81% of these for non-cirrhotic patients. Within this group, Ribavirin was prescribed to 25% of the requests, compared to 64% of prescriptions for the group of cirrhotic patients. Naïve patients without cirrhosis had an average prescription of 268 capsules/treatment and naive patients with cirrhosis used 291 capsules/treatment. If this proportion is maintained and the NHCEP target is reached, it is estimated that 10,125 patients will stop using ribavirin annually, which will save approximately USD 7 million by the end 2024. In Brazil, a significant proportion of patients are treated with ribavirin with no relevant established benefit and at an increased risk for adverse event occurrence. The budgetary impact of the new recommendation will entail savings of public resources, contributing to its sustainability, simplification of hepatitis C treatment and patient safety.