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Global coverage of HBV treatment remains low despite declining costs
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The international market price of generic tenofovir, prequalified by WHO for hepatitis B virus infection, declined more than 85% from 2004 to 2016, according to recent MMWR data. Still, only one in six patients diagnosed with HBV infection worldwide received treatment in 2016.
Yvan Hutin, MD, PhD, medical epidemiologist from WHO’s department of HIV and the Global Hepatitis Program, and colleagues found that treatment coverage was low in low- and middle-income countries (LMICs), even though most these countries could legally procure generic versions of both WHO-recommended HBV medications, entecavir and tenofovir.
“Although the price of medicines effective against HBV infection have decreased sharply in LMICs, the findings from this analysis indicate underutilization of low-price, generic medicines effective against HBV,” the researchers wrote.
In 2016, the World Health Assembly endorsed goals set by WHO to reduce 90% of HBV and hepatitis C virus incidence and 65% of hepatitis-related mortality worldwide by 2030. To reach these goals, Hutin and colleagues said it will be important to scale up treatment coverage.
To monitor progress toward WHO’s goals, the researchers estimated the global care cascade for HBV infection. They examined the patent and licensing status of entecavir and tenofovir, as well as their international costs. The cost of tenofovir was estimated using WHO’s global price reporting mechanism, which reports the market price of WHO-prequalified supplies for HIV. Because entecavir is not a first-line HIV medication, Hutin and colleagues estimated its price based on findings from a 2015 study.
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WHO estimated there were 257 million people living with HBV worldwide in 2016. Among them, only 10.5% (27 million) were aware of their infection, and of these patients, just 16.7% (4.5 million) were receiving treatment. Coverage was highest in upper-middle income countries at 22%.
In 2017, all LMICs could procure generic entecavir, and all but China and Mexico could produce generic tenofovir. The lowest reported cost of entecavir was $427 per year in 2015. In 2016, the average cost of generic tenofovir was $32 per year — a more than 85% reduction from the average cost in 2004, which was $208 per year. The reduction in cost correlated with increasing access to tenofovir-based ART regimens for patients with HIV.
The researchers concluded that access to HBV treatment could increase if countries take advantage of reduced antiviral costs.
“Greater community awareness and better understanding of the national disease burden, access to and availability of affordable diagnostics, and trained providers are needed to promote increased access to care,” they wrote. – by Stephanie Viguers
Reference:
Hutin Y, et al. MMWR Morb Mortal Wkly Rep. 2018;doi:10.15585/mmwr.mm6728a2.
Disclosures: The authors report no relevant financial disclosures.
Perspective
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Chari Cohen, DrPH, MPH
Those of us at the Hepatitis B Foundation were pleased that this MMWR pointed out some of the important barriers for patients living with HBV. The biggest issue that we are dealing with globally is that people are not getting tested enough. When a disease affects 292 million people and less than 10% are being diagnosed, of course, the treatment rates are going to be low. Even among those who are diagnosed, most countries’ infrastructures do not allow patients to receive sustainable care and treatment. Even though the costs have been going down for treatment, there are still so many barriers for patients. Often, they live in places where they cannot find a doctor to prescribe treatment, or doctors do not know what treatment to prescribe. There are patients who cannot even afford the reduced cost rates.
In general, there is a tremendous lack of knowledge among both health care providers and community members. We must ensure that HBV becomes a high-priority disease around the world. It is astounding that almost 900,000 people die from HBV each year. Also, almost 300 million people are infected with HBV, but there is almost no universal testing or access to care and treatment anywhere in the world. We need multi-stakeholder prioritization. Governments must start putting money into HBV testing, treatment and linkage to care, as well as HBV cure research. It is not only governments — corporate partners, nonprofit organizations, medical institutions, medical organizations and doctors also need to prioritize the disease. If not, we are certainly not going to eliminate HBV by 2030.
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