Challenge to deliver curative treatment to all patients with hepatitis C

Hepatitis C virus (CC BY-SA 2.0 AJC ajcann.wordpress.com/Flickr)

Despite the existence of a cost-effective cure for hepatitis C, Dr Graham Cooke explains that universal access for patients is still some way off.

Viral hepatitis is a major cause of death worldwide, with the World Health Organisation estimating 1.4 million lives lost each year; primarily due to liver cancer and cirrhosis as a result of chronic hepatitis B and C infection. Viral hepatitis is now responsible for more deaths each year than TB, HIV or malaria.

For the estimated 214,000 people chronically infected with hepatitis C (HCV) in the UK, there are now better options for a cure. A ‘new generation’ of direct-acting antiviral drugs (DAAs) aimed at the virus have been shown to cure over 90% of people with HCV in only 12 weeks.

However, as Dr Graham Cooke, a clinical academic in the Department of Medicine, explains, there are significant logistical and financial hurdles to get past before universal treatment can be achieved. A 12-week course of the new drug sofosbuvir in the US is priced at as much as $84,000 per person and over £30,000 in the UK.

“These medications are unusual as although they are cost-effective cures, they also affect high numbers of people and so the potential impact on health budgets are currently beyond most health systems.

Given the nature of the disease and treatment, the NHS is currently only able to provide treatment to those with the most advanced liver disease.”

New treatments have been restricted in other countries, such as Australia; where there has been media coverage of patients who have travelled to India to purchase pharmaceuticals they are unable to access at home.  There they have been able to secure more affordable generic versions of the same new medications that have been made available for poorer parts of the world by the originator company.

Dr Cooke highlighted that this tactic is not limited to Australia: “We are starting to see our patients doing the same here; coming to the clinic for advice on how to take the drugs they have procured elsewhere. This creates clear moral and ethical dilemmas for the staff involved.” 

The next key challenge is to establish the most cost-effective way to deliver treatment to all patients with hepatitis C in the UK. Dr Cooke continued: “We need to do more to ensure access to those without advanced disease in this country and we are in discussions with NHS England to support new trials to do just that.”