“Sell an Ox” - The Price of Cure for Hepatitis C in Two Countries

Document Type : Perspective


1 School of Public Health, Hadassah-Hebrew University of Jerusalem, Jerusalem, Israel

2 Department of Internal Medicine, Gondar University Hospital, University of Gondar, Gondar, Ethiopia

3 Medical School for International Health, Ben Gurion University, Beersheva, Israel

4 Department of Public Health & Policy, London School of Hygiene and Tropical Medicine, London, UK


Chronic hepatitis C virus (HCV) infection, associated with severe liver disease and cancer, affects 70 million people worldwide. New treatments with direct-acting-antivirals offer cure for about 95% of affected individuals; however, treatment costs may be prohibitive in both the poorest and richest nations. Opting for cure may require sacrificing essential household assets. We highlight the financial dilemmas involved, drawing parallels between Ethiopia and the United States, countries where universal health coverage does not yet exist. The World Health Organization (WHO) declaration for HCV eradication by 2030 will only become reality if universal access to efficacious and affordable treatment is guaranteed for everyone.


Main Subjects

  1. Global prevalence and genotype distribution of hepatitis C virus infection in 2015: a modelling study. Lancet Gastroenterol Hepatol. 2017;2(3):161-176. doi:10.1016/s2468-1253(16)30181-9
  2. Wei B, Ji F, Yeo YH, et al. Systematic review and meta-analysis: real-world effectiveness of direct-acting antiviral therapies in chronic hepatitis C genotype 3 in Asia. BMJ Open Gastroenterol. 2018;5(1):e000209. doi:10.1136/bmjgast-2018-000209
  3. United Nations. About the Sustainable Development Goals. https://www.un.org/sustainabledevelopment/sustainable-development-goals/.  Accessed April 10, 2019.
  4. Hurley R. Slashed cost of hepatitis C drugs spurs drive to eliminate the disease. BMJ. 2018;361:k1679. doi:10.1136/bmj.k1679
  5. Waheed Y, Siddiq M, Jamil Z, Najmi MH. Hepatitis elimination by 2030: progress and challenges. World J Gastroenterol. 2018;24(44):4959-4961. doi:10.3748/wjg.v24.i44.4959
  6. World Health Organization (WHO). The world health report 2000: health systems: improving performance. Geneva: WHO; 2000.
  7. EASL recommendations on treatment of hepatitis C 2018. J Hepatol. 2018;69(2):461-511. doi:10.1016/j.jhep.2018.03.026
  8. Kollewe J. Non-profit’s $300 hepatitis C cure as effective as $84,000 alternative. The Guardian. April 12, 2018. http://www.theguardian.com/science/2018/apr/12/non-profits-300-hepatitis-c-cure-as-effective-as-84000-alternative.  Accessed March 23, 2019.
  9. Assefa Y, Hill PS, Ulikpan A, Williams OD. Access to medicines and hepatitis C in Africa: can tiered pricing and voluntary licencing assure universal access, health equity and fairness? Global Health. 2017;13(1):73. doi:10.1186/s12992-017-0297-6
  10. Behnke R. The contribution of livestock to the economies of IGAD member states: study findings, application of the methodology in Ethiopia and recommendations for further work. Addis Ababa, Ethiopia: IGAD Livestock Policy Initiative; 2010.
  11. Ayele G, Jabbar MA, Teklewold H, Mulugeta E, Kebede G. Seasonal and inter-market differences in prices of small ruminants in Ethiopia. J Food Prod Mark. 2006;12(4):59-77. doi:10.1300/J038v12n04_05
  12. Tadesse F. To buy or not to buy. https://addisfortune.net/articles/to-buy-or-not-to-buy/.  Accessed March 23, 2019. Published 2019.
  13. Nosratnejad S, Rashidian A, Dror DM. Systematic review of willingness to pay for health insurance in low and middle income countries. PLoS One. 2016;11(6):e0157470. doi:10.1371/journal.pone.0157470
  14. World Bank. Global Findex Database. Washington DC: World Bank; 2019. https://globalfindex.worldbank.org/.  Accessed April 10, 2019.
  15. Hepatitis C Online. Glecaprevir-Pibrentasvir Mavyret - Treatment 2019. https://www.hepatitisc.uw.edu/page/treatment/drugs/glecaprevir-pibrentasvir.  Accessed  November 27, 2019.
  16. Lavers T. Towards Universal Health Coverage in Ethiopia's ‘developmental state’? the political drivers of health insurance. Soc Sci Med. 2019;228:60-67. doi:10.1016/j.socscimed.2019.03.007
  17. Armour S. Number of Uninsured Americans Rises for First Time in Decade. Wall Street Journal. 2019. https://www.wsj.com/articles/number-of-americans-without-insurance-shows-first-increase-since2008-11568128381.  Accessed November 27, 2019.
  18. Saab S, Jimenez M, Fong T, et al. Accessibility to oral antiviral therapy for patients with chronic hepatitis C in the United States. J Clin Transl Hepatol. 2016;4(2):76-82. doi:10.14218/jcth.2016.00011
  19. Sagonowsky E. AbbVie's new pan-genotypic hepatitis C drug Mavyret deeply underprices the competition. FiercePharma website. https://www.fiercepharma.com/pharma/abbvie-s-new-pan-genotypic-hep-c-drug-mavyret-undercuts-competition.  Accessed March 23, 2019.
  20. Jung JK, Feldman R, Cheong C, Du P, Leslie D. Coverage for hepatitis C drugs in Medicare Part D. Am J Manag Care. 2016;22(6 Spec No.):SP220-226.
  21. Marcus JL, Hurley LB, Chamberland S, et al. Disparities in initiation of direct-acting antiviral agents for hepatitis C virus infection in an insured population. Public Health Rep. 2018;133(4):452-460. doi:10.1177/0033354918772059
  22. DeBose-Scarlett A, Balise R, Kwon D, et al. Obstacles to successful treatment of hepatitis C in uninsured patients from a minority population. J Transl Med. 2018;16(1):178. doi:10.1186/s12967-018-1555-y
  23. Cutshaw CA, Woolhandler S, Himmelstein DU, Robertson C. Medical causes and consequences of home foreclosures. Int J Health Serv. 2016;46(1):36-47. doi:10.1177/0020731415614249
  24. Shrime MG, Weinstein MC, Hammitt JK, Cohen JL, Salomon JA. Trading bankruptcy for health: a discrete-choice experiment. Value Health. 2018;21(1):95-104. doi:10.1016/j.jval.2017.07.006
  25. Henry B. Drug pricing & challenges to hepatitis C treatment access. J Health Biomed Law. 2018;14:265-283.
Volume 9, Issue 6
June 2020
Pages 229-232
  • Receive Date: 12 October 2019
  • Revise Date: 06 December 2019
  • Accept Date: 07 December 2019
  • First Publish Date: 01 June 2020