World Hepatitis Day this year comes at a time of unprecedented optimism for the future, but is also a good time for us to take stock of what has been achieved so far.
The new, highly effective oral therapies which are the cause of such optimism are also posing huge challenges to health care systems around the world, who must secure the benefits for patients whilst wrestling with competing and increasing demands for resources.
In England, the NHS addressed the issue with a phased introduction of treatment, focusing first on those with greatest need. Major investment in an ‘early access programme’ made all-oral antiviral therapy available to English patients with decompensated cirrhosis, prior to drug licensing and NICE evaluation, and has led to dramatic improvements in the health of around 1,000 patients.
Meticulous data collection was a major part of this programme, and this allowed us to assess the impact of treatments in real time and to issue guidance to others, in the form of two peer-reviewed publications in the Journal of Hepatology.
The early access investment was successful in improving access to care, but also served to highlight gaps in services across the country.
To address this, leading clinicians across the country worked with NHS England to design ‘operational delivery networks’ (ODNs), sharing and spreading expertise, including to regions that had never provided hepatitis C services before
The ODNs are now fully functional. As national leads, we review the information about how they are performing on a weekly basis, ensuring any emerging issues are identified and rapidly addressed.
As services continue to develop in the previously-underserved areas, we are closing in on hitting 95% of our planned treatment rate, and more than 4 in 5 patients are getting the identified best value, clinically-appropriate option for them.
Results published by Public Health England today indicate the startling success of this approach – by focusing on the sickest patients we have reduced mortality from hepatitis C by over 10% in the space of just one year. Few other disease areas have seen such a dramatic improvement so quickly, and everyone involved in delivering these treatments deserves great credit for achieving so much in such a short period of time.
As we near completion of the task of treating the patients with the most severe disease, attention turns to the next challenge: identifying those patients at greatest future risk.
Our CQUIN incentive scheme is delivering significant investment to providers to improve and promote the expansion of services for patients. Our collective aim over the next year is to begin to expand treatments to more challenging patient groups, with particular emphasis on those at risk of transmitting the infection.
We will also be collecting more data to confirm that the therapies are contributing to reducing new infections, as well as identifying, and therefore helping to mitigate, the risks of re-infection. Collecting these data won’t be easy, but is a worthwhile investment of effort and resource, helping us further maximise the effectiveness of treatment and services over the coming years.
Achieving best value for the treatments themselves, in line with other developed healthcare systems internationally, clearly also remains a key plank of our plan to expand and improve services for patients.
At the time of writing, we are waiting to see the prices that companies have put forward to the Department of Health to take effect from September. In parallel to this, NHS England agreed with the Department of Health that we would put in place a process for the industry to come forward with more innovative, longer-term proposals to allow us to treat more patients within our available resources.
During the past 3 months we have met with all the leading pharmaceutical companies to outline our plans and share thinking. There are no shortcuts, but early dialogue has been promising, and we will shortly begin the more formal stage of the process.
This important work speaks directly to the recommendation from the Public Accounts Committee this month that the Department of Health, NHS England and NICE need to work together to ensure affordability is considered when making decisions that have an impact on specialised services.
These are exciting times for all those involved in improving services for patients with chronic HCV. We should rightly celebrate the achievements that have been made, as set out by Public Health England today. But we are under no illusion that the challenge of working towards eliminating HCV will require a great deal more from all of us over the months and years ahead.
Peter Huskinson is the National Commercial Director of Specialised Commissioning at NHS England. He joined the NHS in 2003 after a successful career in industry, and has worked in a range of commissioning and transformation roles with responsibility for primary, community acute and mental health care. He co-chairs NHS England’s National Programme of Care Board for Blood and Infection overseeing the work of clinical reference groups in infection, immunity and haematology.
Professor Graham Foster is Professor of Hepatology at Queen Mary University of London and the clinical lead for hepatology at Barts Health. Professor Foster was the founding President of The British Viral Hepatitis Group, a past President of the British Association for the Study of The Liver and is a trustee of the Hepatitis C Trust. He was appointed as National Clinical Chair for the Hepatitis C Delivery Networks in January 2016.