Hepatitis C in the era of elimination: the choice of therapeutic regimens taking into account pharmacoeconomics on the example of the Leningrad region
Authors:   Saint Petersburg State Pediatric Medical University, Saint Petersburg, Russian Federation, Esaulenko E.V. ,   Pasteur Saint Petersburg Scientific Research Institute of Epidemiology and Microbiology, Saint Petersburg, Russian Federation, Kovelenov A.I. ,   Center for Prevention and Control of AIDS and Infectious Diseases, Saint Petersburg, Russian Federation, Novak K.E. ,   Saint Petersburg State Pediatric Medical University, Saint Petersburg, Russian Federation, Stasishkis T.А. ,   Center for Prevention and Control of AIDS and Infectious Diseases, Saint Petersburg, Russian Federation, Dzemova A.A. ,   Saint Petersburg State Pediatric Medical University, Saint Petersburg, Russian Federation, Ibrohimova A.D. ,   Saint Petersburg State Pediatric Medical University, Saint Petersburg, Russian Federation,   Pasteur Saint Petersburg Scientific Research Institute of Epidemiology and Microbiology, Saint Petersburg, Russian Federation
Published: March 2024

Objective. To characterize the dynamics of the epidemic situation of chronic hepatitis C (HCV) in the Leningrad region (LR) for the period 2015–2022 and establish the most promising for therapy in LR schemes. Materials and methods. The data of Form No 2, the Federal Register of Patients with viral hepatitis, the Reference Center for Monitoring Viral Hepatitis, the chief freelance specialist in infectious diseases of the LO were used. To assess the effectiveness of various tactics of HCV therapy, the method of pharmacoeconomical analysis – "cost-effectiveness" was used. As a criterion for evaluating the economic effectiveness of therapy, the cost of one cured patient was shown, calculated according to the formula: the cost of one cured patient = the cost of the course / the effectiveness of the regimen. Results. Based on the cost-effectiveness analysis, it was revealed that in patients with HCV genotype 3, it is advisable to use pangenotype schemes, and patients with HCV Gt1b can be effectively treated with genotype-specific combinations. Stable positive dynamics in the main epidemiological indicators (morbidity, mortality, cumulative number, coverage of therapy) HCV is not traceable in the LO. Following the draft passport of the strategy to combat HCV and based on the cumulative number of patients in the LO, by 2025 It is necessary to cover more than 4,000 people with therapy, primarily about 1,700 patients with a late stage of the disease (F3–F4). In the LO, persons with the 3 genotype of the virus (48%), requiring the use of pangenotype regimens and with the 1b genotype (41%), who are able to be treated with genotype-specific schemes, predominate. Conclusion. In order to achieve the goal of elimination in the LO, it is necessary to increase screening. To improve the quality of examination of patients with HCV (PCR, genotyping, elastometry, etc.), it is necessary to develop and implement an outpatient diagnostic tariff of Mandatory Medical Insurance. Key words: Leningrad region, chronic hepatitis C, direct antiviral drugs, pangenotypic schemes, genotype-specific schemes, pharmacoeconomical analysis