Global disparities in access to hepatitis C medicines before and during the early phase of the COVID-19 pandemic: an ARIMA-based interrupted time series analysis
Notice bibliographique
Résumé
Background: The introduction of direct-acting antivirals (DAAs) has allowed countries to reduce the health and economic burden of hepatitis C virus (HCV). However, access to DAAs remains expensive and limited in many countries globally due to wide disparities in HCV drug pricing. We assessed how global use of HCV drugs has changed over time and the effect that COVID-19 might have had on DAA utilisation. Methods: We assessed longitudinal changes in DAA sales by country income group, geographical region and drug type. We also conducted an interrupted time series analysis to assess COVID-19-related changes in the trend of DAA units sold globally. Our analysis used DAA sales data from the IQVIA multinational integrated data analysis database of 52 countries and two regions and HCV prevalence data from Polaris from 2014 to 2020. Our primary outcome was the monthly rate of DAAs sold per 100 000 people living with HCV per country, country income group and geographic region. We then compared the pre-post change in DAA units by drug type and country income group. We fitted autoregressive moving average models with a ramp function to assess the impact of COVID-19 on monthly DAA units sold. Results: Across all countries, from August 2014 to August 2020, a monthly average of 44 219 DAA units per 100 000 HCV cases was sold. High-income countries purchased more units than other groups. In terms of geographic location, North America (124 144 per 100 000 HCV cases) and Europe (81 001 per 100 000 HCV cases) had the highest DAA sales over time; the newer generation of combination DAAs was mainly used in high-income countries. In contrast, first-generation and second-generation DAAs were the predominant types of DAAs sold in lower middle-income countries (LMICs). The pre-post analysis showed a 23% (p<0.001) average decrease in global sales of DAAs during the first phase of COVID-19. The decrease in LMICs (69%, p<0.001) was approximately double that of high-income countries (33%, p<0.001), while upper middle-income countries (UMICs) had a 34% (p<0.001) increase in DAA sales. The pandemic was associated with an immediate and sustained decrease of 9263 units per month (95% CI -14 668 to -3857.46) in high-income countries, a 73.14 (-850.96 to 997.24) unit increase in UMICs and a 742.58 (95% CI -5505.91 to 4020.75) unit decrease in LMICs. Conclusion: Our study showed uneven access to DAAs globally, with higher prevalence-adjusted utilisation in high-income countries compared with lower-income countries. Our study also found that the COVID-19 pandemic has significantly decreased DAA sales in many countries. To counter these trends, additional strategies, such as price reductions, increased competition among manufacturers and licensing agreements, may help to improve access and utilisation of DAAs globally.
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Comment cette classification a été obtenuedéplier
Prédiction distillée sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Apprise à partir de 10 348 étiquettes directes de Codex et de 10 348 étiquettes directes de Gemma. Le mode candidate est l'union des têtes enseignantes seuillées; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont ni des étiquettes humaines ni des étiquettes directes de modèles de pointe.
Scores Codex et Gemma par catégorie
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,002 | 0,003 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,001 | 0,000 |
| Bibliométrie | 0,001 | 0,003 |
| Études des sciences et des technologies | 0,000 | 0,000 |
| Communication savante | 0,000 | 0,000 |
| Science ouverte | 0,000 | 0,000 |
| Intégrité de la recherche | 0,000 | 0,000 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,000 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule tête enseignante, pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».