MEP FRIENDS OF THE LIVER GROUP MEETING Hepatitis C: …...Hepatitis C: Policy in Action ... Private hospitals were charging over 100k Euros to treat Hepatitis C. Advocats from all

Hepatitis C: Policy in Action

RICARDO BAPTISTA LEITE, MP, MD, PhD(C) Medical Doctor and Member of the Portuguese Parliament

Member of the Parliamentary Health Committee | Foreign Affairs Committee

Head of Public Health | Católica University of Portugal

Guest Lecturer | NOVA Medical School and NOVA Information Management School

City Councilor of Cascais

[email protected] | @RBaptistaLeite

MEP FRIENDS OF THE LIVER GROUP MEETING

22nd March 2017 | Brussels, Belgium

Portugal: Cascais – Sintra – Estoril Coast

@RBaptistaLeite


Health in the Portuguese Constitution

PORTUGUESE

NHS

QUALITY

ACCESS

CITIZEN CENTERED

TENDENCY TO BE

FREE OF CHARGE

GLOBAL

UNIVERSAL COVERAGE

@RBaptistaLeite


The Evolution of Healthcare in Portugal

LIFE EXPECTANCY AT BIRTH INFANT MORTALITY RATE (PER 1000 LIVE BIRTHS)

@RBaptistaLeite



HEALTH EXPENDITURE PER CAPITA BELOW THE AVERAGE OF OECD COUNTRIES (OECD, 2011)

PORTUGAL - 2619

@RBaptistaLeite



ECONOMIST INTELLIGENCE UNIT | TOP TIER BY OUTCOMES (EIU, 2014)

@RBaptistaLeite


2011 | TROIKA@Portugal

@RBaptistaLeite


Hepatitis C in Portugal

@RBaptistaLeite


Consensus for HIV

2011 2T/2013 May

2014

June -December

2014

December

2014 Febuary 2015 Today

@RBaptistaLeite


HCV Paradigm Shift

Católica University of Portugal Institute of Health Sciences

Public Health Unit

2T/2013 May

2014 2011

June -December

2014

December


Consensus Method®

Review scientfic data

Collect data from main stakeholders (Think Tank)

Consensus paper to support future decisions on

how to manage hepatitis C in Portugal, from a

public policy perspective: from prevention to

cure @RBaptistaLeite


HCV | The Research to Policy Gap

Only ~50 patients with Hepatitis C were treated with 3rd

generation antiviral drugs (special authorizations)

Negotiations between Ministry of Health and Pharma Industry

went on behind closed doors. Absolute uncertainty on what

would be the outcome of those negotiations.

Private hospitals were charging over 100k Euros to treat

Hepatitis C.

Advocats from all fields were demanding a decision,

including a possible patent violation (under the Doha treaty), to

save lives.

June -December

2014 2011 2T/2013

May

2014

December


@RBaptistaLeite


HCV | The Research to Policy Gap

December

2014 February Today

2011 2T/2013 May

2014

June -December

2014


The Tipping Point

February 2015 December

2014 Today

2011 2T/2013 May

2014

June -December

2014

“DON’T LET ME DIE!” José Carlos Saldanha

“DON’T LET ME DIE!” José Carlos Saldanha @RBaptistaLeite


HCV | When Research meets Policy

The Ministry of Health announced an agreement with Gilead Sciences and Harvoni® was fully funded for all patients with Hepatitis C.

Risk sharing model was adopted. The Ministry agreed on paying per patient that is clinically cured (not per number of weeks of treatment nor per number of patients treated) and the payment procedures were fully centralized.

Volume-based agreement: Price paid is inversely proportional to the number of patients treated.

National Action Plan for Hepatitis C and the review of the national HCV treatment guidelines were announced and are currently being prepared by a panel of experts.

Centralized registry database was commissioned and is currently used by physicians.

2 days later…

February 2015

@RBaptistaLeite


Hepatitis C in Portugal

Today

pathtozero.eiu.com Source: Ministry of Health PT, 3rd February 2017 @RBaptistaLeite

Over 15,000 patients that have been diagnosed with chronic

HCV in the NHS have been included

10.168 patients have initiated treatment

5.249 PATIENTS CURED

96,47% SVR


Making Change Happen

2016 | Vienna, Austria

Policy change is possible using

EDD:

vidence-based

ata-Driven

ecision-Oriented Policy Making

@RBaptistaLeite

LET’S END HEPC:

DECLARATION OF INTERESTS

Gilead Sciences Europe Ltd is providing financial support for this project.

ROAD TO ELIMINATION

DASHBOARD

Institute of Health Sciences | Católica University of Portugal

Public Health Unit

@RBaptistaLeite

LET’S END HEPC

Road to Elimination Dashboard

1 Elimination demands a holistic approach:

Awareness and Prevention strategies Diagnosis of all cases of HCV Ensure linkage-to-care for all patients diagnosed Guarantee access to treatment

2 Still, we face regional disparities:

No surveillance mechanisms available It has become impossible to assess if we are truly on the road to eliminate Hepatitis C We are unable to perform a comparative analysis at the country level Lack of appropriate tools needed to make evidence based decisions

@RBaptistaLeite

LET’S END HEPC


3 We need a tool that integrates

Open data policy surveillance digital

platform

Indicators from each link of the “Hepatitis C value

chain”: Awareness & Prevention

Diagnosis Linkage to Care

Treatment Cure

Country comparative analytic tools at the

service of all

Prospective impact assessment of indicator

adjustments

@RBaptistaLeite

LET’S END HEPC


@RBaptistaLeite

LET’S END HEPC


@RBaptistaLeite

“If Europe doesn't take on a leadership

position, any hope of meeting commitments

to end the epidemics of HIV and AIDS,

[hepatitis] and tuberculosis…by

2030 will be doomed to fail.”

More needs to be done…

With the support and under the auspices of

Renate Baehr

in Politico

THE ANSWER

@RBaptistaLeite

And Lastly…

@RBaptistaLeite

Never,

Never,

Never, stop fighting

for better health for all

@RBaptistaLeite

Documents

MEP FRIENDS OF THE LIVER GROUP MEETING Hepatitis C: …...Hepatitis C: Policy in Action ... Private hospitals were charging over 100k Euros to treat Hepatitis C. Advocats from all