“Revolutionary” treatment against hepatitis C: the sickest first

deux-medicaments-appeles-harvoni-holkiraThis is a first in Quebec. Fear of having to pay a bill that would have reached a billion dollars this year, Quebec has decided to reimburse qualified drug “revolutionary” can cure hepatitis C … but, initially, only for sickest patients.

Under the rules adopted yesterday by the Régie de l’assurance maladie du Québec (RAMQ), so that some hepatitis C patients Quebecers will have to wait three years before getting access to new treatments that could cure them.

“Yes, that’s a first. This is an exceptional measure that is implemented in exceptional circumstances. We tried to make the most responsible possible model, “said Friday in La Presse Stéphane Ahern, President of the Scientific Committee of the National Institute of excellence in health and social services (INESSS), the body responsible for evaluate drugs.

The measures concern two drugs called Harvoni respectively Holkira Pak. They are intended for patients with hepatitis C genotype 1, which represent 60 to 70% of cases in Quebec. And can lead to complete healing of patients within 8 to 12 weeks.

The catch: this treatment costs 55 000 to 60 000 per patient. If Quebec had repaid treatment to all concerned Quebecers, the government estimates that it would have had to face a bill of a billion dollars in the first year. The never-seen in Quebec for a drug.

“One of the big elements of the decision is the fiscal impact that would have been imposed on the regime in the short term,” admits Mr Ahern. This is the first time that a drug so expensive key as many patients in the province.

To avoid the rush and the consequent fiscal shock, Quebec has decided to treat the sickest patients first. Those who have what is called a “score Metavir” F3 or F4 can be treated now. Patients to a lesser extent (score F1 or F2) will have to wait a year before being reimbursed treatment. And it is only in three years that all patients will have access.

“Quebec patients receiving this message today, perhaps with a certain amount of distress, need to know that they should not abandon their doctor. They must have followed up, “says Ahern.

“I do not think we should associate the context of austerity in this kind of analysis, not at all,” Mr Ahern also responded to a question from La Presse.


Mersilian Laurence, CEO of versatile associative Centre Hepatitis C Assistance (CAPAH) welcomed the decision of Quebec to reimburse the two drugs in question.

“This is an important step, but there is a big downside. We do not even jump when the ceiling, “she began.

“I have many patients awaiting these drugs. Doctors have slowed some current treatments saying you will soon have access to a much shorter treatment with fewer side effects. But many of them today do not have this opportunity. It’s a shame, “she continues.

“It would have been better to treat everyone right away, also said Réjean Thomas, founder and CEO of the clinic l’Actuel. But in the circumstances I guess it’s acceptable. ”

Besides having an efficiency of almost 100% and to act quickly, and Harvoni Holkira Pak also have the advantage of not causing distressing side effects of drugs of the previous generation.

“It’s a medical revolution as we had not seen in years,” comments Stéphane Ahern, INESSS.

By spreading treating Quebec patients over several years, Quebec is indeed different objectives. The first is obviously to mitigate the fiscal impact, but Mr Ahern also expressed hope that new drugs began to appear by then, which would cause competition and reduce prices. He said that Quebec did not have the medical and logistical capacity to handle everyone anyway, and these measures will ensure that those who suffer most will be the first patients to receive care.

More difficult patients

There is another element in the equation.

“Unfortunately, in Quebec, the majority of our patients are former or active drug addicts,” says Ahern. However, these patients are often difficult to treat. Therefore INESSS proposed that in parallel to the repayment Harvoni and Hokira Pak, a monitoring program is implanted patients. And this takes time.

“This is an element to be taken into account, said Mr Ahern. We need to let the resources to prevent the patient is treated today is contaminated again tomorrow. ”

Ahern admits that there is a risk that they do not give patients immediately infect others. However, it considers that the risk is “limited” and mainly affects injecting drug users.

Hepatitis C

Potentially fatal disease that attacks the liver
Is transmitted through blood
70 000 to 80 000 people infected in Quebec, 60% are affected by genotype 1
200: the number of new cases per year in the province
– Sources: INSPQ and versatile associative Help Center Hepatitis C

The Stopru