title: [In Process Citation].
abstract: Approximately 70.000 people are infected with hepatitis C virus in Hungary, more than half of whom are not aware of their infection. From the point of infected individuals early recognition and effective treatment of related liver injury may prevent consequent advanced liver diseases and complications (liver cirrhosis, liver failure and liver cancer) and can increase work productivity and life expectancy on one hand. From socioeconomic aspect, this could also prevent further spread of the virus as well as reduce substantially long term financial burden of related morbidity. Available since 2003 in Hungary, pegylated interferon + ribavirin dual therapy can clear the virus in 40-45% of previously not treated (naïve), and in 5-21% of previous treatment-failure patients. Addition of a direct acting first generation protease inhibitor drug (boceprevir or telaprevir) to the dual therapy increases the chance of sustained virologic response to 63-75% and 59-66%, respectively. These two protease inhibitors are available and financed for a segment of Hungarian patients since May 2013. Between 2013 and February 2015, other direct acting antiviral interferon-free combination therapies have been registered for the treatment of chronic hepatitis C, with a potential efficacy over 90% and typical short duration of 8-12 weeks. Indication of therapy includes exclusion of contraindications to the drugs and demonstration of viral replication with consequent liver injury, i.e., inflammation and or fibrosis in the liver. Non-invasive methods (eleastography and biochemical methods) are accepted and preferred for staging liver damage (fibrosis). For initiation of treatment accurate and timely molecular biology tests are mandatory. Eligibility for treatment is a subject of individual central medical review. Due to budget limitations tharpy is covered only for a proportion of patients by the National Health Insurance Fund. Priority is given to those with urgent need based on a Hungarian Priority Index system reflecting primarily the stage of liver disease, and considering also additional factors, i.e., activity and progression of liver disease, predictive factors of treatment and other special issues. Approved treatments are restricted to the most cost-effective combinations based on the cost per sustained virologic response value in different patient categories with consensus between professional organizations, National Health Insurance Fund and patient organizations. More expensive therapies might be available upon co-financing by the patient or a third party. Interferon-free treatments and shorter therapy durations preferred as much as financially feasible. A separate budget is allocated to cover interferon-free treatments for the most-in-need interferon ineligible/intolerant patients, and for those who have no more interferon-based therapy option. Orv. Hetil., 2015, 156(Suppl. 2), 3-24.
authors.affiliation: Gasztroenterológia Osztály, Somogy Megyei Kaposi Mór Oktató Kórház Kaposvár, Tallián Gy. u. 20-32., 7400.|I. Belgyógyászati Klinika, Pécsi Tudományegyetem, Általános Orvostudományi Kar Pécs.
authors.forename: Béla
authors.initials: B
authors.lastname: Hunyady
authors.affiliation: Transzplantációs és Sebészeti Klinika, Semmelweis Egyetem, Általános Orvostudományi Kar Budapest.
authors.forename: Zsuzsanna
authors.initials: Z
authors.lastname: Gerlei
authors.affiliation: Belgyógyászat és Molekuláris Diagnosztikai Laboratórium, Szent György Egyetemi Oktató Kórház Székesfehérvár.
authors.forename: Judit
authors.initials: J
authors.lastname: Gervain
authors.affiliation: Hepatológiai Szakrendelés, Budapest és Budai Hepatológiai Centrum, Szent János Kórház és Észak-budai Egyesített Kórházak Budapest.
authors.forename: Gábor
authors.initials: G
authors.lastname: Horváth
authors.affiliation: II. Belgyógyászati Klinika, Semmelweis Egyetem, Általános Orvostudományi Kar Budapest.
authors.forename: Gabriella
authors.initials: G
authors.lastname: Lengyel
authors.affiliation: I. Belgyógyászati Klinika, Pécsi Tudományegyetem, Általános Orvostudományi Kar Pécs.
authors.forename: Alajos
authors.initials: A
authors.lastname: Pár
authors.affiliation: II. Belgyógyászati Klinika, Semmelweis Egyetem, Általános Orvostudományi Kar Budapest.
authors.forename: Zoltán
authors.initials: Z
authors.lastname: Péter
authors.affiliation: I. Belgyógyászati Osztály, MH Egészségügyi Központ Honvédkórház Budapest.
authors.forename: László
authors.initials: L
authors.lastname: Rókusz
authors.affiliation: Infektológia Osztály, Markusovszky Egyetemi Oktatókórház Szombathely.
authors.forename: Ferenc
authors.initials: F
authors.lastname: Schneider
authors.affiliation: I. Belgyógyászati Klinika, Semmelweis Egyetem, Általános Orvostudományi Kar Budapest.
authors.forename: Ferenc
authors.initials: F
authors.lastname: Szalay
authors.affiliation: Orvos- és Egészségtudományi Centrum, Belgyógyászati Intézet, Debreceni Egyetem, Általános Orvostudományi Kar Debrecen.
authors.forename: István
authors.initials: I
authors.lastname: Tornai
authors.affiliation: II. Belgyógyászati Klinika, Semmelweis Egyetem, Általános Orvostudományi Kar Budapest.
authors.forename: Klára
authors.initials: K
authors.lastname: Werling
authors.affiliation: Egyesített Szent István és Szent László Kórház Budapest.
authors.forename: Mihály
authors.initials: M
authors.lastname: Makara
keywords: asunaprevir; boceprevir; daclatasvir; dasabuvir; direct acting antiviral drug; direkt ható antivirális szer; elbasvir; genotype; genotípus; grazoprevir; hepatitis C virus; hepatitis C-vírus; hepatocellular cancer; interferon; ledipasvir; liver cirrhosis; májrák; májzsugor; ombitasvir; paritaprevir; pegilált interferon; pegylated interferon; polimeraseinhibitor; polimerázgátló; protease-inhibitor; proteázgátló; ribavirin; ritonavir; simeprevir; sofosbuvir; telaprevir; viral hepatitis; vírushepatitis