title: Transformation of hepatitis C antiviral treatment in a national healthcare system following the introduction of direct antiviral agents.
abstract: Highly effective direct antiviral agents (DAAs) for hepatitis C virus (HCV) were introduced recently. Their utilisation has been limited by high cost and low access to care.
  
  
  
  To describe the effect of DAAs on HCV treatment and cure rates in the United States Veterans Affairs (VA) national healthcare system.
  
  
  
  We identified all HCV antiviral treatment regimens initiated from 1 January 1999 to 31 December 2015 (n = 105 369) in the VA national healthcare system, and determined if they resulted in sustained virological response (SVR).
  
  
  
  HCV antiviral treatment rates were low (1981-6679 treatments/year) in the interferon era (1999-2010). The introduction of simeprevir and sofosbuvir in 2013 and ledipasvir/sofosbuvir and paritaprevir/ombitasvir/ritonavir/dasabuvir in 2014 were followed by increases in annual treatment rates to 9180 in 2014 and 31 028 in 2015. The number of patients achieving SVR was 1313 in 2010, the last year of the interferon era, and increased 5.6-fold to 7377 in 2014 and 21-fold to 28 084 in 2015. The proportion of treated patients who achieved SVR increased from 19.2% in 1999 and 36.0% in 2010 to 90.5% in 2015. Within 2015, monthly treatment rates ranged from 727 in July to 6868 in September correlating with the availability of funds for DAAs.
  
  
  
  DAAs resulted in a 21-fold increase in the number of patients achieving HCV cure. Treatment rates in 2015 were limited primarily by the availability of funds. Further increases in funding and cost reductions of DAAs in 2016 suggest that the VA could cure the majority of HCV-infected Veterans in VA care within the next few years.
authors.affiliation: Divisions of General Internal Medicine, University of Washington, Seattle, WA, USA.
authors.forename: A M
authors.initials: AM
authors.lastname: Moon
authors.affiliation: Health Services Research and Development, Veterans Affairs Puget Sound Healthcare System, Seattle, WA, USA.
authors.forename: P K
authors.initials: PK
authors.lastname: Green
authors.affiliation: Health Services Research and Development, Veterans Affairs Puget Sound Healthcare System, Seattle, WA, USA.
authors.forename: K
authors.initials: K
authors.lastname: Berry
authors.affiliation: Divisions of General Internal Medicine, University of Washington, Seattle, WA, USA.|Health Services Research and Development, Veterans Affairs Puget Sound Healthcare System, Seattle, WA, USA.|Gastroenterology, Veterans Affairs Puget Sound Healthcare System and University of Washington, Seattle, WA, USA.
authors.forename: G N
authors.identifier: 0000-0003-1796-8977
authors.initials: GN
authors.lastname: Ioannou
mesh_terms: D000998:Antiviral Agents / Q000627:therapeutic use*; D004359:Drug Therapy, Combination / Q000639:trends; D005260:Female; D016174:Hepacivirus / Q000235:genetics; D006526:Hepatitis C / Q000097:blood / Q000188:drug therapy* / Q000821:virology; D006801:Humans; D008297:Male; D008875:Middle Aged; D009310:National Health Insurance, United States; D012367:RNA, Viral / Q000097:blood; D014481:United States; D014493:United States Department of Veterans Affairs
chemical_list: D000998:Antiviral Agents; D012367:RNA, Viral