The Professor of Hepatology at Queen Mary University of London, and NHS England’s National Commercial Director of Specialised Commissioning, update on the progress of the Hepatitis C (HCV) programme:
As we go into the New Year, the Hepatitis C (HCV) programme is set to pass a major milestone.
The number of patients in England having received the new direct acting antiviral treatments will pass the 25,000 mark.
The 22 Operational Delivery Networks (ODNs) across the country were tasked to expand rates of treatment by 25 per cent from April this year, and nine months on are delivering at over 90 per cent of those goals. The continued increase in patients receiving antiviral therapy reflects the sustained leadership and commitment of clinicians, staff and partner organisations in each local area.
In September, we made a new treatment option – Glecaprevir/Pibrentasvir – available for patients, following on from the Early Access to Medicines Scheme. We also moved to a new pay-per-cure deal for the NHS – this means that for the one in 20 patients who complete their treatment but do not achieve a cure (known as sustained virologic response) the NHS is refunded the cost of drugs.
This resource has been invested in increasing the run rate and offering re-treatment to patients with decompensated cirrhosis whilst we await the NICE review of re-treatments for patients with milder disease.
The new approach means we are able to manage the increase in treatment rates within the same resources, as well as now being able to offer selected patients re-treatment with extended duration therapy. At the same time, we also took the decision that all first line therapies should be interferon free, so the very significant inconvenience and side effects of this drug can be avoided.
The launch of the Hepatitis C registry will make it possible to monitor treatment uptake and outcomes in near real-time. The progress towards getting more complete data in the registry is encouraging, and our goal is for the registry to be the definitive source of outcomes data for all patients the NHS has treated and for all patients with diagnosed chronic HCV yet to be treated.
We hope to be able to introduce a regular update on treatment response allowing colleagues to track our progress towards the WHO goals to eliminate HCV as a major public health concern by 2030.
One trend shown by treatment records is that the proportion of patients with cirrhosis undergoing therapy continues to fall, indicating good progress on treating those with the highest unmet clinical need. This is reflected in the reduction in HCV mortality, indicating that we are beginning to impact upon the harms caused by this virus.
The HCV programme will move to the next level in its expansion from April, with a further rise in annual planned treatment rates to 13,000.
In support of this continued expansion, an updated CQUIN incentive has been made available to hospitals who host the ODNs. Networks are measured to achieve between 90% and 110% of their planned treatment goals, rather than 90 per cent – 100 per cent, and to focus on establishing stronger links with pathology laboratories and supporting opt-out testing arrangements in local prison, drug and alcohol and sexual health services.
Our progress in treating patients with advanced disease means the challenge ahead is increasingly to expand therapy to patients with mild disease where the pressure and desire for therapy is reduced and where lifestyle choices in some cases make treatment administration more difficult.
Reports from the ODNs indicate that the networks are rising to the challenge. Brighton’s initiative, to treat people who are homeless, and the Manchester targeted treatment service indicate the ingenuity and determination of colleagues who are pushing the boundaries of treatment access so that we can reduce the transmission of HCV and reap even greater rewards from these new therapies.
Peter Moss, Chair of the Humberside and North Yorkshire network, reports on their introduction of a highly effective programme contacting patients diagnosed many years ago and lost to the service. Their data suggests that this approach is welcomed and leads to a significant number of ‘re-engagements’ allowing treatment of people diagnosed many years ago.
We would like to thank our colleagues and partner organisations around the country for their continued support of the programme. Here’s to a very exciting 2018 as we look to go further.