Hepatitis C programme is making huge progress

The Hepatitis C treatment programme in England has now been operational for over a year – so what better time to review its progress than today, World Hepatitis Day?

Following the success of the Early Access Programme, NHS England established 22 operational delivery networks across the country to ensure national access to antiviral therapy.

All of the networks are now up and running and new treatment services have been established in regions where, previously, access to Hepatitis C therapy was very limited. We are now confident that everyone in England has access to antiviral treatment, no matter where they live.

The focus of the initial phase of the Hepatitis C programme was to treat patients with the most advanced disease, to reduce morbidity and mortality in those at highest risk of imminent harm.

In line with NICE recommendations, Networks have prioritised patients and over the last 12 months we have seen a marked reduction – from 70% to 30% – in the proportion of patients with cirrhosis who are receiving antiviral therapy as more and more patients are successfully treated.

And, despite the high proportion of patients with advanced disease who have received antiviral therapy, the response to treatment has been very impressive with over 90% of patients achieving a sustained virological response.

As hoped, the prioritisation of patients in greatest need has led to a rapid reduction in deaths from chronic HCV, by as much as 10%, as well as a fall in the number of patients with Hepatitis C requiring liver transplantation, with early data indicating a 50% reduction in liver transplants for chronic HCV infection.

Now that we have addressed patients in greatest need, the focus of the programme will begin to shift towards reducing the burden by treating patients with early disease with the aim of reducing onward viral transmission.

Networks have been asked to draw up plans to increase engagement and diagnosis in the community and over the next few weeks we will be looking at ways that we can further incentivise their focus from treating patients on their waiting list to identifying patients who are currently unaware of their infection.

In addition to putting in place clinical support through the operational delivery networks, we’ve also taken commercial steps over the last year to improve access to treatment. We’ve provided funding for a fibroscanner for each of the networks which helps establish the level of fibrosis in the liver and helps with the prioritisation of patients with advanced disease. We’ve worked to support access to new treatments as soon as possible and have used our role as the purchaser of Hepatitic C Virus drugs to improve the deal we get for the taxpayer in England. Working with clinicians to ensure the lowest cost treatments, which will achieve cure are used ahead of more expensive options, is making it possible to drive down the cost per person so we can treat more patients within available funding.

This year we will increase the number of patients who will have access to cure using new direct acting antivirals by 25%, from 10,000 to 12,500. We have been pleased to make Glecaprevir/Pibrentasvir available for patients with no other treatment options who are at imminent risk and likely to benefit from therapy, through the early access to medicines scheme.

A key component of the HCV programme is the collection of accurate information, both on patients who are receiving treatment and patients who have been identified and are waiting for therapy. The new Hepatitis C registry is now operational and the collection of accurate data about patients will be critical to further developing the programme over the next few years.

The WHO has ambitious targets to reduce the burden of chronic Hepatitis C over the next few years. The English Hepatitis C programme got off to a flying start with the early access scheme and the benefits have been consolidated with the establishment of a national network of treatment centres and increasing access to therapy.

We are confident that with the support of our colleagues around the country we can continue to reduce the harm caused by Hepatitis C and we look forward to the time when we regard it as a rare infection and an uncommon cause of cirrhosis and liver cancer.

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.

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 and NHS England’s Hepatitis C (HCV) Elimination Programme in January 2016.