Burnet Institute, Melbourne, Australia.
Barcelona Institute for Global Health (ISGlobal), Hospital Clínic, University of Barcelona, Barcelona, Spain.
BMC Med. 2018 Oct 9;16(1):175. doi: 10.1186/s12916-018-1162-z.
Direct-acting antivirals (DAAs) have dramatically changed the landscape of hepatitis C treatment and prevention. The World Health Organization has called for the elimination of hepatitis C as a public health threat by 2030. However, the discrepancy in DAA prices across low-, middle- and high-income countries is considerable, ranging from less than US$ 100 to approximately US$ 40,000 per course, thus representing a major barrier for the scale-up of treatment and elimination. This article describes DAA pricing and pathways to accessing affordable treatment, providing case studies from Australia, Egypt and Portugal. Pathways to accessing DAAs include developing comprehensive viral hepatitis plans to facilitate price negotiations, voluntary and compulsory licenses, patent opposition, joint procurement, and personal importation schemes. While multiple factors influence the price of DAAs, a key driver is a country's capacity and willingness to negotiate with pharmaceutical companies. If negotiations do not lead to a reasonable price, governments have the option to utilise flexibilities outlined in the Agreement on Trade-Related Aspects of Intellectual Property Rights. Affordable access to DAAs is underpinned by collaboration between government, civil society, global organisations and pharmaceutical companies to ensure that all patients can access treatment. Promoting these pathways is critical for influencing policy, improving access to affordable DAAs and achieving hepatitis C elimination.
直接作用抗病毒药物（DAAs）极大地改变了丙型肝炎治疗和预防的格局。世界卫生组织呼吁到 2030 年消除丙型肝炎这一公共卫生威胁。然而，低、中、高收入国家之间 DAA 价格差异相当大，每疗程价格从不到 100 美元到大约 40000 美元不等，因此成为扩大治疗和消除规模的主要障碍。本文介绍了 DAA 的定价和获得负担得起的治疗的途径，提供了来自澳大利亚、埃及和葡萄牙的案例研究。获得 DAA 的途径包括制定全面的病毒性肝炎计划，以促进价格谈判、自愿和强制许可、专利异议、联合采购以及个人进口计划。虽然有多个因素影响 DAA 的价格，但一个关键驱动因素是一个国家与制药公司谈判的能力和意愿。如果谈判不能达成合理的价格，政府可以选择利用《与贸易有关的知识产权协定》中规定的灵活性。通过政府、民间社会、全球组织和制药公司之间的合作，确保所有患者都能获得治疗，从而实现 DAA 的负担得起的可及性。促进这些途径对于影响政策、改善获得负担得起的 DAA 的机会以及实现丙型肝炎消除至关重要。
