New treatment for hepatitis C has opened up massive opportunity for all-round health gains that we are just not taking , hears DDN
Hepatitis C
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New treatment for hepatitis C has opened up massive opportunity for all-round health gains that we are just not taking , hears DDN
We need to look at syndemics , said Charles Gore – when a set of linked health problems such as hepatitis C , drug and alcohol issues , mental health and homelessness interact to increase the person ’ s poor state of health and chances of disease . As chief executive of the Hepatitis C Trust and vice chair of the Hepatitis C Coalition , Gore was speaking to the Drugs , Alcohol and Justice Cross-Party Parliamentary Group about access to treatment .
In Scotland , treating people who injected drugs for hepatitis C had reduced death rates for this group by 50 per cent – ‘ so treating hepatitis C might be a way of breaking this syndemic apart ’, he said .
People who were treated were more motivated to address other factors , he explained , ‘ so hep C treatment has a bigger effect than you might think ’. There had been ‘ great breakthroughs ’ in hep C drugs , which had a 95 per cent cure rate and were very tolerable to take ( compared to previous treatment , which took a year and was ‘ very unpleasant ’) – ‘ so we ’ re in a new era here ’, he said .
In England there were around 160,000 people with hepatitis C , but a budget to treat only 10,000 of them . Treating all of them , at a cost of around £ 200m , would be ‘ a lot of money – but not compared to other disease areas ’.
The first year of new drugs had seen an 11 per cent decrease in mortality and a 50 per cent decrease in demand for liver transplants . ‘ The gains in terms of health are enormous ,’ said Gore .
The reasonably short course of eight to 12 weeks for the new treatment also meant there could be a big impact on treating people in prison .
Despite this , hep C testing and treatment levels in prison were low and prevention strategies ‘ quite muddled and not homogenous across the prison estate ’, failing to tackle the common transmission routes of shared needles , tattooing and sex .
In the community , there were wide variations in treatment strategy throughout the UK . In Wales , health boards had put money aside but could not find enough people to treat , while in England , a cap on
numbers was stopping many people from accessing treatment . ‘ Some areas of the country have massive waiting lists , but some are running out of people ,’ said Gore . Financial incentives for finding and following up people after treatment also risked making low priority cases of those who were hard to follow up – ie the drug-using population .
The NHS was investigating procurement deals with pharmacies , and Gore explained that the Hepatitis C Trust had a preferred model of ‘ one price for an unlimited amount of treatments , so there would be a great incentive to treat as many people as possible . At the moment , the system disincentivises treatment and the cap disincentivises testing .’
Treating the prison population represented a ‘ huge opportunity ’, Gore believed – ‘ It ’ s one area where you could send people out of prison better than they went in .’ There were 10,000 people in prison with hepatitis C , and ‘ if we took this population and treated them we could make a big difference ’.
The current cap and rationing system did not prevent members of the population with advanced liver disease from being treated as a priority . The problem was for those who had to wait two years – ‘ and this assumes you ’ re in services ,’ he explained . ‘ But you may be in prison . You may be a person who might not be in touch with services again , and when you do , you may have liver cancer .’ Prison might be the only chance you have to treat them , so we were missing a significant public health opportunity , he said .
Gore also underlined ‘ the tremendous importance ’ of linking with people who are released from prison , who might be part way through treatment . ‘ If we concentrated on prisoners ’ health , we would have a much better chance of improving their chances .’
The parliamentary group ’ s discussion reflected PHE and NHS England ’ s need to work together on a hep C prevention strategy , but there was concern that ‘ fragmented commissioning ’ was hampering efforts , with costs falling in different parts of the system and no ‘ strategic flow ’ between them .
‘ There ’ s a lot of joining up to do ,’ said Gore . ‘ People who spend and people who gain are different people .’
The first year of new drugs has seen an 11 per cent decrease in mortality and a 50 per cent decrease in demand for liver transplants . ‘ The gains in terms of health are enormous .’
Charles Gore
20 | drinkanddrugsnews | April 2017 www . drinkanddrugsnews . com