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Background: Malaysia has been fully committed to the global endeavor to eliminate hepatitis C virus (HCV) infection by 2030. In early 2018, the Ministry of Health (MOH) embarked on a “one-size-fits-all strategy” by introducing generic versions of sofosbuvir and daclatasvir as the standard treatment for HCV infection in public hospitals nationwide. Objectives: To evaluate the outcomes of such an initiative in multiple aspects, including the number and characteristics of patients treated, the extent of evidence-based drug use, the treatment completion status, individual responses to treatment, common side effects of treatment, and its economic implications. Methods: The findings were generated from the data compiled by the MOH, capturing the information regarding the treatment provided to adult HCV-infected patients in 16 selected hospitals between April 2018 and March 2020, along with the drug costs incurred. Results: A total of 1,797 patients were treated, nearly four times more than the patients receiving interferon-based treatment across the country in the preceding two years. Approximately one-third of them had liver cirrhosis, and the main HCV genotypes were 3 (46.9%) and 1a (20.0%). Dosing, treatment duration and the addition of ribavirin to the treatment generally agreed with the recommendations of the MOH. More than 90% of the patients completed the treatment course, and a sustained virologic response (SVR) rate of 95.4% (95% CI: 94.2, 96.7%) was recorded in those with a known treatment outcome (n = 1,163). The SVR achievement did not vary across HCV genotypes and cirrhosis status, but those ≥ 50 years of age (adjusted OR: 2.13; 95% CI: 1.16, 3.92) were more likely to fail the treatment. Side effects were rare. Anemia and fatigue caused treatment discontinuation in only 0.3% of the patients. The total drug expenditure reached US$678,258.20, and the mean cost of a 12-week treatment course of sofosbuvir and daclatasvir (US$235.16) was lower than the cost expected by the MOH (US$300). Conclusions: The findings demonstrate a high degree of real-world effectiveness, safety, and affordability of the standard treatment, suggesting that such a government-led initiative was reasonable and timely and could be extended to include more public health institutions.

Summary Using a more sensitive fluorimeter than has previously been described in this country, a method is given for estimating riboflavine in malted preparations which gives much better agreement with microbiological assays than had previously been obtained. These preparations when oxidised with permanganate during the purification procedure exhibit a non-specific blue fluorescence which interferes with the fluorimetric assay. In old samples of malt extract this blue fluorescence is quite marked before permanganate treatment. The behaviour of the fluorescent substance with Florisil and its low solubility in chloroform show it not to be lumichrome. It is most effectively separated from riboflavine by adsorption on Florisil and careful elution with 1 per cent. pyridine, the process being observed continuously under the ultra-violet lamp. Spectroscopic studies indicated Wratten 47 as a satisfactory primary filter. Comparison of fluorimetric and microbiological results confirmed this. When calculating the results of riboflavine fluorimetric assays a method based on the assumption that the net fluorescence is proportional to the concentration, and using solvent blanks to determine the net fluorescence, is preferable to the method more usual in this country of using calibration curves obtained by plotting gross fluorescence against concentration. We are indebted to Mr. E. J. Bowen, F.R.S., for advice, to Miss Janet Horsford and Mr. R. Evans for technical assistance, to Mr. G. Slaughter for the fluorescence spectrum of riboflavine, to Messrs.*** Hilger and Watts, Ltd., and Messrs. Kodak, Ltd., for data on the transmission of filters.