Investment in hep C treatment programs needed to support elimination goal.

Source: PharmaDispatch  Author: Paul Cross (December 19, 2017)

Hepatitis Australia is urging government to invest in programs designed to increase the uptake of PBS-listed direct acting antivirals that cure hepatitis C.

Recent statistics have revealed a significant drop-off in uptake of the medicines first reimbursed in March 2016. Recently appointed president of Hepatitis Australia, Felicity McNeill PSM, is the former first assistant secretary of the Department of Health’s Pharmaceutical Benefits Division. She was a key figure in the process leading to their reimbursement.

In its 2018-19 pre-Budget submission, the organisation says, while the rapid initial uptake of treatment far exceeded all expectations with 30,000 people cured during 2016, monthly treatment rates have recently more than halved and this drop-off is likely to continue without intervention. At the same time, new infection notifications currently remain stuck at around 10,000 patients per year.

It says the goal of eradication by 2030 will not be met at these current treatment levels with the implication Australia will be paying higher per patient treatment costs for longer with worse patient outcomes as more people battle the health consequences of the curable virus.

"...the modelling demonstrates that a high annual treatment uptake...produces a much quicker reduction in new cases of hepatitis C infection, rapid declines in the number of people developing hepatocellular cancer (HCC) or dying from complications of hepatitis C infection with the elimination of hepatitis C achieved by 2026."

Hepatitis Australia says government ultimately risks not taking full advantage of the initial five year pricing deal negotiated with manufacturers.

It is understood the deal caps spending on the therapies at around $300 million in each of the five years. As a result, government pays less per patient cured and moves closer to eradication when more patients above the annual utilisation rate of around 15,000 are treated. Falling treatment rates slow the move towards eradication and result in higher per patient treatment costs.

"Based on the current treatment frequency, Government will be paying a higher annual price to maintain access to the treatments with no significant diminution of people needing treatment, and therefore no diminution of costs to the PBS in the out years. Most importantly of all, the target of elimination of this disease in Australia by 2030 will likely be lost," it says.

It proposes government invest $75 million over three years in initiatives that support a renewed uptake of the cures.

It recommends government engage primary health groups, including the Primary Health Networks and professional medical bodies, to assess what initiatives are needed to firmly embed hepatitis C management in primary care.

The decision to enable prescribing of the antivirals by GPs was a world-first and considered a very important step towards achieving eradication.

Hepatitis Australia also recommends digital health initiatives and targeted awareness and support programs for people at risk of hepatitis C, or living with hepatitis C, to help connect them to testing and treatment services.

Hepatitis Australia says the $75 million cost of its proposal is equivalent to 3,750 treatments at the current published market rate of around $20,000 per prescription of the direct acting antivirals.

"Enhancing treatment rates during this time maximises the landmark PBS supply deal the Turnbull Government negotiated. If 3,750 additional treatments are delivered prior to 2022 as a result of the requested $75 million investment, the Government will in effect, break even," it says.

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