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25,000 Hepatitis C patients receive new treatments

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.

Professor Graham Foster

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.

Peter Huskinson

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.

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7 comments

  1. Ashi Varma says:

    It is very useful blog for visiting us any where Please Keep up your thought buetween us .Also visit Modern times Helpline Pharma. http://www.moderntimes-helplinepharma.com/

  2. Rosalind says:

    Had the new tablet treatment for Hep C and was cleared of the virus in 12 weeks. Saved my life. I can’t thank you enough for your research and work.

  3. Mrs Flavell says:

    Extremely interested to see how ODNs intend on engaging with hard to reach drug users. I’m aware that in my local area substance misuse commissioners approached their local heptology department to see if treatment with DAAs could be delivered at the drug service. They were told it was possible but they would have to pay for it – with shrinking public health budgets this wasn’t possible. ODNs need to be far more proactive and flexible about engaging with this group and shouldn’t expect local authorities to stump up additional funding for something that should be covered by NHS England funding.

  4. Kim Crisell says:

    At the current rate of treatment it will take decades to treat all UK infected patients.

    Rather than wait for years to be treated I chose to buy licenced generic Meds from India and was fortunate to be monitored by the NHS.

    I fully appreciate the dilemma the NHS has on funding the treatment and am thankful for their support, I do however object to the obscenely high price charged by the big pharmaceutical companies for a medicine that has minimal costs to produce. I think it is time that an organisation such as the World Health Organisation had the powers to control the prices charged taking into account the investment the pharmaceutical companies and allow a fair profit but not excessive greed.

    If the price of this treatment was affordable and everybody on the planet treated this disease could be eradicated (and the pharmaceutical companies would still get rich.)

  5. Angela Jukes says:

    Please give a precise definition of what you consider to be “mild disease” in patients who are carrying a highly infectious blood borne disease. Why do you think there is a reduced pressure and desire for patients with “mild” treatment to be treated? Not from me there isn’t, nor I suspect from the majority of your patients who are baby boomers. No mention is made of baby boomer C.Hepsters above. Do we matter? I will be reading NICE May 2018 publication with interest. With the horrible stigma of this unpopular disease I will be leaving my name. I can well understand how this killer disease has such a low profile.

    • Prof. Graham Foster says:

      Thank you for your comment. NHSE has invested a record substantial sum in treating patients with hepatitis C. In line with NICE guidelines we have focussed on patients who are likely to die over the next few years and we have very successfully reduced the death rate from hepatitis C. We are now moving to people who are not at imminent risk of death (regarded as mild disease) and we are doing so because, as you highlight, we know that this disease does more than just damage the liver. The NHS continued commitment to finding and treating more patients will allow more and more patients to get rid of this virus with health benefits to all.

      • Angela Jukes says:

        Thank God I could afford the generic and over the internet walk-in-clinic blood tests. Yep, baselines said I was sick, but not sick enough to be treated by NHS. Not facing imminent death. Not part of what seems to be considered an infecting population. Not a child (they are not mentioned). Looks very like I would have been “waited out” by the NHS. Lucky for the Pharma Company I had the generic cash. Some money from me is better than no money for me from the NHS. Needed treating now. Not prepared to lead half a life. Not going to wait for the hope of expansion of treatment programme. A wing and a prayer won’t do. At least help those that don’t have the cash for the generic. Monitor those that can’t afford the lab tests as well as the generic. No need for people to live shadow sick lives. Get them treated.