Combination treatment for hepatitis C is not being given

BMJ 2000; 321 doi: https://doi.org/10.1136/bmj.321.7265.899/a (Published 07 October 2000) Cite this as: BMJ 2000;321:899
  1. G R Foster (g.foster{at}ic.ac.uk), consultant hepatologist,
  2. R Chapman, consultant gastroenterologist
  1. Liver Centre, Imperial College School of Medicine at St Mary's, St Mary's Hospital, London W2 1PG
  2. Department of Gastroenterology, John Radcliffe Infirmary, Oxford OX3 9DU On behalf of C Change

    EDITOR—Current estimates suggest that up to 0.7% (400 000 individuals) of the population of the United Kingdom are infected with the hepatitis C virus.1 In some (roughly 30%) of these people the virus causes a progressive hepatitis that leads to cirrhosis and cancer.2 European guidelines recommend that patients with progressive hepatitis C are treated with interferon and ribavirin.3 This cures 40%4 and leads to an improvement in liver histology and a reduction in morbidity and liver cancer.

    Although expensive, treatment for hepatitis C is cost effective as it reduces the need for liver transplantation. Anecdotal evidence suggests that in the United Kingdom combination treatment is not available to many patients because of restrictions imposed by purchasing authorities.

    To determine if this is the case we conducted a postal survey among clinicians (447 members of the British Association for the Study of the Liver) who had an interest in the treatment of viral liver disease. Usable replies were received from 80 and reflected the views of 68 purchaser areas (55% of the purchasers in the United Kingdom). The results (table) show that adequate funding for interferon and ribavirin is available in only a minority of health districts and that postcode prescribing occurs in the management of patients with this premalignant, treatable disease.

    Response to questionnaire regarding availability of funding for treatment of chronic infection with hepatitis C virus from clinicians representing 68 purchaser areas

    View this table:

    John Denham, minister of state at the Department of Health, has stated in parliament that “The fact that NICE [the National Institute for Clinical Excellence] is considering combination therapy is not a barrier to its prescription and provision.”5 It is unfortunate that this message is not followed by most purchasing authorities.


    • C Change includes most of the major charities representing patients with or at risk from hepatitis C (the British Liver Trust, the Haemophilia Society, Mainliners) as well as individual patients, clinicians, and pharmaceutical companies manufacturing therapeutics for hepatitis C. Competing interests: Dr Foster has been reimbursed for consultancy work and presentations at conferences by manufacturers of drugs used to treat hepatitis C. Dr Chapman has no competing interests.


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