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Low uptake of HCV treatment in England will lead to substantial disease burden by 2035
Michael Carter, 2014-06-13 12:00:00
Only 3% of
patients with chronic hepatitis C virus (HCV) are treated for their infection
each year in England, according to research published in the Journal of Hepatology. The current
uptake of treatment was described as “unacceptable” and likely to result in
1650 cases of end-stage liver disease and cancer each year by 2035. Scaling-up
treatment and using newer drugs has the potential to reduce incidence by a half.
“We must make
treatment for hepatitis C more accessible to patients,” said Charles Gore,
chief executive of the Hepatitis C Trust. “Hepatitis C is a curable disease and
to have so few people being offered the chance to rid themselves of the virus
is simply not acceptable.”
160,000 patients in the UK have chronic HCV infection. This can lead to
permanent liver damage, including liver cirrhosis and liver cancer. However, the
infection can be cured with treatment. Currently this is based on pegylated
interferon and ribavirin. This therapy doesn’t always work and can cause
unpleasant side-effects. All-oral highly effective treatments are in
development and will be available shortly, but they are likely to be very expensive.
Government’s Hepatitis C Action Plan for England called for “high quality
services for the assessment and treatment of all patients.”
A team of
investigators used national records to assess the number of patients
who accessed HCV therapy annually between 2006 and 2011 and to assess the
impact of various treatment strategies on the future burden of HCV disease of
the next 30 years, as well as the costs associated with caring for patients with the
The number of
patients treated for HCV each year rose from 3234 in 2006 to 5316 in 2010. But
uptake then slowed between 2010 and 2011.
28,000 patients received therapy between 2006 and 2011, meaning that only 3%
of the chronically infected population accessed treatment each year.
Maintaining this level of
treatment uptake would result in 1650 new cases of HCV-related end-stage liver
disease and liver cancer each year by 2035.
treatment levels by 50% and 100% would modestly reduce the number of cases of end-stage liver
disease and liver cancer, to 1470 and 1360 cases per year, respectively.
order to avoid such a substantial disease burden, the newer, more
therapies need to be used and must be scaled up so as to achieve 100%
coverage. This could reduce annual incidence of serious liver disease to
and 620 cases by 2035.
The cost of purchasing drugs for large
numbers of people would be substantial, especially if the newer, more
expensive therapies are used. However this expense must be offset
against savings in other healthcare costs, such as the management of end
stage liver disease and liver transplantation.
Increasing the uptake
of existing therapies by 50% and 100% would increase
treatment-associated costs by £460 million and £740 million over the
next 30 years, respectively. Rapidly implementing complete coverage of
new therapies was estimated
to cost £1460 million.
While these costs are substantial, if current drugs are used at current levels of coverage, the total
healthcare costs for caring for the HCV-infected population over the next 30
years would be much higher, at around £4680
“While there would
be a financial cost to rapidly increasing treatment rates, the increase is not
as great as you might think because the costs of managing undiagnosed and untreated
hepatitis C are so high,” commented Dr Helen Harris of Public Health England.
“Currently, we are paying a very high price in terms of lives lost and burden
placed on future health cost resources.”
The study authors
call on NHS commissioners to “consider expanding provision of treatment in
non-traditional settings, including primary care, drug treatment centres and
They conclude, “it
is vital to make treatment more accessible for those groups who need it most
and address the health inequalities that result from excess premature deaths
from HCV-related liver disease in marginalised populations.”