Treatment Coverage and Drug Expenditure in Hepatitis C Patients From 2013 to 2019: A Journey of Improving Treatment Accessibility in Malaysia Through Government-led Initiatives

Background: Hepatitis C is a public health threat, affecting approximately 1.9% of the Malaysian population. Objectives: This study demonstrates how a series of initiatives taken by the Ministry of Health (MOH) of Malaysia have impacted the treatment coverage and drug expenditure for hepatitis C patients since 2013, the year in which the first direct-acting antiviral (DAA) was introduced in public health institutions. Methods: The data were obtained from all the 144 hospitals and 33 primary healthcare centers throughout the country, which were identified to have offered the pharmacological treatment to hepatitis C patients over the last seven years. Results: The total number of hepatitis C patients treated each year was shown to increase by more than 10 times, reaching 3,116 in 2019. However, the drug expenditure for hepatitis C relative to the overall health expenditure did not significantly increase over time (P = 0.094). The use of DAAs was once limited by its exorbitant cost. A remarkable elevation in the number of patients receiving the treatment only took place as of 2016, particularly following the engagement of the MOH in endeavors driven by non-profit organizations to enhance the accessibility of DAAs and the issuance of a compulsory license to sofosbuvir. Conclusions: Timely decisions of the MOH and the judicious use of policy tools were shown to have transformed the landscape of hepatitis C management in Malaysia without considerably raising the budgetary pressure. Yet, continuous efforts to massively upscale the screening and treatment of the disease are warranted going forward.