Globally, Hepatitis C affects 130-150 million people. With antiviral medications, approximately 90% of those millions can be cured.
However, antiviral medications are costly, and even in developed countries many governments struggle with which medications should be subsidized and when. In Canadian patients suffering from Hepatitis C, a virus that causes liver disease and often worsens into a chronic condition, treatment can be expensive. Currently, Canadians with chronic HCV have limited access to Direct Anti-viral Agents (DAAs), the most effective existing treatment for the infection.
Assistant professor William W.L. Wong’s research will help both national agencies and provincial formularies make these challenging cost/benefit (cost-effectiveness) decisions about drug coverage and HCV. A specialist in pharmacoeconomics, Dr. Wong and his team have received $470,169 from the current Canadian Institute of Health Research project grant to measure the patient burden of HCV, which involves measuring health-related quality of life, the effect of HCV on workplace productivity, and HCV’s cost to patients.
“What is missing in the literature,” says Dr. Wong, “is an understanding of the patient perspectives of Hepatitis C. In particular, we are missing information on whether treatment improves health related quality of life in the long run.
In order to help governments formulate reimbursement policies, that is - whether or not a government should fund a medication, we need to understand what the impact is on the patient’s overall health-related quality of life.
Health-related quality of life is a concept that takes into account the impacts of physical, mental, emotional and social functioning domains. By measuring this particular variable, Dr. Wong’s research will clarify exactly how people respond to treatment with DAAs.
His study will encompass approximately 600 patients in three Canadian cities: Calgary, Toronto and Montreal. Through a wide variety of survey and measurement tools, he will gather data from patients who undergo DAA treatment for Hepatitis C (pre-and post-treatment), and from patients who are living with chronic Hepatitis C at a late-stage of the disease.
By studying both patients who are undergoing treatment, and patients with late-stage chronic Hepatitis C, we’ll gain a better understanding of the whole spectrum. We will see what DAAs do for quality of life in patients at all stages of the infection’s progression.
This data is important for national agencies and provincial drug formularies that have to make difficult decisions about when a drug should be covered by the government. The benefits of treatment may be more significant for patients at an early stage of infection, or vice versa. Government bodies can use that knowledge of when a drug is most effective to help them determine when financial coverage is most necessary.
Dr. Wong will also study the economic burden the disease puts on patients. Hepatitis C is a debilitating infection that often impacts work productivity. Treatment locations can require patients to travel. Time off work and decreased job efficiency can cascade into significant out-of-pocket costs for patients, and it’s important that decision-makers understand those associated costs.
“Patients from different backgrounds face different challenges when it comes to paying for medications,” Dr. Wong explains. “By understanding the trends in Hep C patients’ economic circumstances, we can make more informed decisions and have a fuller appreciation of the overall health burden of the disease.”
Dr. Wong is currently recruiting two Masters students, and one Post-Doctorate fellow to participate in HCV-related research projects. Interested applicants can contact Dr. Wong at wwlwong@uwaterloo.ca.