Stop C in Action – Is It Working?

By Nanuka Bregadze

According to Hepatitis C elimination program, launched in April 2015, American company “Giliard” provides Georgia with new effective drugs Sofosbuvir and Harvon for free to treat people infected with hepatitis C virus (HCV).

Georgia became a model country for the company because of the low population and high prevalence rate (6.7% of population).

Before the elimination program, the main drug against Hepatitis C was pegylated Interferon (peg-INF) in combination with Ribavirin (RBV). In 2010, the average cost of treatment in Georgia was $20,000 and in 2012 $15,000.

Mamuka Cukhishvili, 39, received a treatment for six months. He used 1200 pills of Ribavirin and 21 ampoules of Interferon. The whole price was 1,700 Gel (about $680).

“The price on one-year treatment course ranged from 25,000 to 40,000 Gel ($10,000-16,000 and six-month course took from 15 000 to 22 000 Gel" - says Cukhishvili.

Because of the cheaper price, some countries prefer to treat with generics, but this practice is still very weak in Georgia.

For example, in Egypt, with the highest prevalence (25%) In 2004, a local private company introduced a biosimilar version of peg-INF with the name Reinferon RetardÒ, which is nearly 26% of the price of imported peg-INF (USD 205) and costs $53 per ampoule.

Georgian patients also had the chance to be treated with Reinferon but because of bureaucratic issues the government didn’t allow them on the market.

“It was an important for saving patient’s life and for the competition on the market”- says Mariam Chokheli, medicine's Availability program manager in Open Society Georgia Foundation.

India, Bangladesh and other Asian countries also produce generics for HCV treatment.

“Although Giliard provides us the whole needed amount of Sofosbuvir and Harvon for free, we still need genericsbecause, for effective result, some patients need to be treated with combined drugs produced by other company (Sofosbuvir +Interferon, Ribavirin)” - says Paata Sabelashvili, civil activist and elimination program supervision commission member.

Mamuka Zoidze, 46, was diagnosed with Hepatitis C fifteen years ago. Because of his critical health condition, compensated liver cirrhosis (F4), he was automatically involved in the first stage of elimination program. The treatment lasted for three months and ended on 14 September, 2015.

“I got three boxes of Sofosbivir and 12 ampoules of Interferon with Ribavirin“- says Zoidze.

More than 6000 people had been involved in the first stage of elimination program.

According to the document provided by parliament, 90 percent of them are being treated.

The second stage will start in February and nearly 20 000 patients will be involved each year.

In the budget of 2016, the government of Georgia allocated 22 million GEL ($8.8 million) for hepatitis C management.

Before the patient gets involved in hepatitis C elimination program, some diagnostics are needed. When the program starts, patient does the analyses once in four weeks and the last one for the final result.

Because there was no money for elimination program in the previous year’s budget, the government only partially covered the costs of the diagnostics - 70% for socially vulnerable patients and 30% for others.

“First time I spent 500 Gel ($200) and 30% was financed by the government. After elastography and monitoring analyses, I paid more than 1000 Gel ($400) to find out the genotype of the virus”- says Zoidze.

Although in budget of 2016 8 million Gel ($3.2 million) is allocated for diagnostics and studies necessary for monitoring of the treatment process, the government doesn’t have criteria for spending it and there is no money for the side effects management.

“Examples of side effects are anemia, leucopenia, thrombocytopenia, etc., that in most cases is regulated by reducing the dose”- says Maia Butsashvili, doctor infectiologist.

“often hemoglobin rate is getting lower which is life-threatening. The treatment is expensive and it’s hard for socially vulnerable families to pay” - says Mariam Chokheli.

Also, according to Paata Sabelashvili, because of the wrong drug policy, too many people are arrested for the lowest dose and in this case it’s hard to think about elimination of hepatitis C virus.