Midterm Outcome Evaluation of Government-Led Endeavors to Eliminate Hepatitis C (HCV) as a Public Health Threat by 2030 in Malaysia

Introduction Malaysia has been actively battling hepatitis C since 2016, primarily through partnerships with access-oriented nonprofit organizations and drug price control by compulsory licensing of sofosbuvir, a patented direct-acting antiviral. This study evaluated the impact of such initiatives on the treatment coverage, health expenditure of the government, and clinical outcomes of patients.    

Methods The data contributed by 144 public hospitals across the country was used to assess the trend changes in the number of hepatitis C patients treated and the corresponding drug expenditure between 2013 and 2019 (before and after government-driven interventions). The information on the effectiveness of the sofosbuvir-daclatasvir regimen was also gathered from medical records of hepatitis C patients, who sought care from 16 selected hospitals between April 2018 and March 2020.    

Results While the number of hepatitis C patients receiving treatment increased by >10 times (from 299 in 2013 to 3,116 in 2019; p<0.001), drug expenditure on hepatitis C relative to the overall health expenditure was not significantly expanded over time (p=0.094). Treatment completion was reported in 91.1% of the 1,797 patients studied for their clinical outcomes, who recorded a sustained virologic response (complete cure) rate of 95.4% (95% CI: 94.2, 96.7%). Treatment outcomes varied across neither viral genotypes nor cirrhosis status. Nevertheless, an age ≥50 years elevated the treatment failure risk (adjusted OR: 2.13; 95% CI: 1.16, 3.92).    

Conclusion The findings demonstrate the sustainability and scalability of the existing hepatitis C care model in Malaysia, along with the great real-world effectiveness of the treatment. 

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