Challenges for Resource Allocation, Decision Making and Consideration of Social Values for Screening, Diagnosis and Treatment of Hepatitis C in Canadian Populations

• Author / Creator

  O'Keefe-Markman, Caroline

• Introduction: Health care system decision makers face challenges in allocating resources for screening, diagnosis and therapies for hepatitis C, caused by the highly infectious and blood borne hepatitis C virus (HCV) (WHO, 2014). Approximately 240,000 individuals are infected with HCV in Canada (PHAC, 2013), and HCV is the leading cause of liver transplants (Canadian Liver Foundation, 2012). Populations most affected by HCV include indigenous peoples, persons who use injection drugs (PWID), the homeless, immigrants and prison inmates as well as persons born between 1946-1965 (baby boomers) (Government of Alberta, 2016). A new suite of curative but expensive drug regimens, novel direct acting antivirals (DAAs), have become available for hepatitis C.
  Objectives: I analyzed approaches to screening, diagnosis and treatment of hepatitis C in a resource-constrained environment. The recent adoption of DAAs for the treatment of hepatitis C combined with the constellation of marginalized and dominant populations affected, necessitates a re-evaluation of these approaches. In addition, I explored how health system decision-makers might make resource allocation decisions, which dominantly relies on cost effectiveness analyses, might consider a systematic, transparent and reproducible set of social values in HTA beyond utility.
  Methods: I conducted a scoping review of academic literature to identify and analyze the social values and evidence-based recommendations for screening, diagnosis and treatment of Hepatitis C in Canada. In parallel, I analysed 22 semi-structured interviews with policy makers, public health experts and clinicians in one Canadian province, Alberta, on barriers, challenges and resource allocation in the context of Hepatitis C.
  Results and Implications: My scoping review demonstrated that the academic literature can be used to identify an expanded set of social values that might be considered by decision makers in resource-constrained environments. This literature clearly calls for greater consideration of equity and justice and the duty to provide care that accounts for consideration of individual and community interests. Further, it calls for more tailored approaches to screening, diagnosis and treatment of Hepatitis C that considers a broader range of social values, especially with respect to marginalized populations.
  My analysis of expert interviews suggested there is an overall lack of access to care and no consensus on screening, diagnosis and treatment of Hepatitis C. However, approaches need to address the social determinants of health that vary between affected populations and provide considerations beyond a biomedical model of health.

• Subjects / Keywords

  • Hepatitis C
  • HCV
  • Social Values
  • Screening
  • Diagnosis
  • Treatment

• Graduation date

  Fall 2018

• Type of Item

  Thesis

• Degree

  Master of Science

• DOI

  https://doi.org/10.7939/R3NP1X12M

• License

  Permission is hereby granted to the University of Alberta Libraries to reproduce single copies of this thesis and to lend or sell such copies for private, scholarly or scientific research purposes only. Where the thesis is converted to, or otherwise made available in digital form, the University of Alberta will advise potential users of the thesis of these terms. The author reserves all other publication and other rights in association with the copyright in the thesis and, except as herein before provided, neither the thesis nor any substantial portion thereof may be printed or otherwise reproduced in any material form whatsoever without the author's prior written permission.