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Slashed cost of hepatitis C drugs spurs drive to eliminate the disease

BMJ 2018; 361 doi: https://doi.org/10.1136/bmj.k1679 (Published 16 April 2018) Cite this as: BMJ 2018;361:k1679
  1. Richard Hurley
  1. The BMJ

Unimaginable just a few years ago, new drugs for hepatitis C are becoming affordable for all, reports Richard Hurley

Access to hepatitis C virus testing and treatment should be expanded now that effective, curative drugs are so affordable, the World Health Organization said on 13 April. The advice comes two years after the agency made a global commitment to eliminate all types of viral hepatitis by 2030.1

Until recently, such a promise felt like pie in the sky. Eye watering launch prices of drugs such as sofosbuvir of around $90 000 (£63 000; €73 000) per patient in the US and almost £35 000 in England meant that even rich countries were restricting access to direct acting antiviral combinations when they launched, some five years ago.

In the UK, NHS England took action in 2015 to ensure that only the sickest patients had access to the drugs, although they were recommended by the National Institute for Health and Care Excellence.2 But in January this year the agency promised that England would be the “first in the world” to eliminate hepatitis C by 2025, beating WHO’s deadline by “at least five years.”3

The change of policy seems to have come after NHS England secured deals with manufacturers, reducing the cost of a course of treatment to about £5000 a patient, says Charles Gore, chief executive of the UK advocacy group the Hepatitis C Trust.

Worldwide, everyone over 12 should now receive treatment regardless of the disease’s severity, say imminent WHO guidelines announced on 13 April at the International Liver Congress in Paris, France.4 Prevention, testing, and treating should be embedded in countries’ broader service delivery, they say.

Gottfried Hirnschall, director of WHO’s HIV/AIDS Department and the Global Hepatitis Programme, told The BMJ, “We need an aggressive stepping-up of the pace. The treatment is simple, can be given in primary care, and is curative.”

Oral, fixed dose combinations of direct acting antiviral drugs taken once a day for 8-12 weeks can cure six common genetic variants of the hepatitis C virus, making expensive genotyping redundant. Elimination rates exceed 90%, and the life saving treatment is now cost saving because of the substantial reduction in liver cirrhosis or cancer, as well as diseases such as depression and diabetes.

Last month the UK All Party Parliamentary Group on Liver Health outlined “a vision for a national elimination strategy,” recommending how the government should fund prevention, case finding, testing, and treatment.5

Gore said, “The NHS was worried about initial prices, but it’s completely turned around, and now they’re worried about finding people to treat.” The bloodborne infection carries a stigma because it is often transmitted by sharing needles when injecting drugs, which was probably more common before dangers such as HIV transmission were known about.

At least 80 000 symptomless people in England do not know that they have the infection, he explained, and 50 000 others have tested positive but have been lost to follow-up.

“We need to make it easy for anonymous testing, in pharmacies, for example. And we need a public awareness campaign,” said Gore. Another challenge, he added, is getting different healthcare commissioners to prioritise the issue in drug services, community nursing, and prison care.

Hirnschall said that “champion countries” such as Egypt and Pakistan, which have some of the heaviest burdens of hepatitis C virus infection, show what can be achieved with government action. Currently, they account for half of the total number of people receiving treatment.

In other countries, such as Malaysia and India, compulsory and voluntary licensing has led to generic production and lower treatment costs.

Unpublished interim trial results presented at the Paris conference showed that generic drugs costing just $300 have shown over 95% effectiveness in Malaysia and Thailand.6

“A cure for hepatitis C cure has sparked momentum. Patients are demanding it. Now politicians need to step up,” said Hirnschall, calling for a response similar to that seen with HIV: political leadership, international solidarity, and considerable funding, as well as civil society commitment.

“The alternative is more costly and will cost more lives,” he said. “We cannot wait.”

Hepatitis globally

  • Viral hepatitis of all types kills 1.3 million people a year worldwide—more than HIV, malaria, or tuberculosis.

  • Last year 1.7 million people became infected with hepatitis C, and 1.5 million were cured.

  • Only three million of the 71 million people infected with hepatitis C virus in 2017 had access to direct acting antiviral drugs, and only 20% of people know their status.

References

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