I read the letters from Charles Gore (
Clinical Pharmacist 2016;8:232) and Anja St. Clair Jones (
Clinical Pharmacist 2016;8:264) on the therapies and new services for hepatitis C with interest. The points made are valid and important.
The key issues highlighted by Gore were related to the fact that there are real restrictions placed on accessing the newer therapies for this infection that have not been imposed in other disease areas, with other medicines, in other patients. Resources are limited; however, denying individuals timely access to National Institute for Health and Care Excellence-approved, evidence-based, cost-effective therapies is, indeed, exceptional.
St. Clair Jones points out the advances that have been made — the effective early access programme for the newer therapies, the setting up of functional operational delivery networks, the potential for accurate data collection, etc, — and although these are undoubtedly true, the direct rationing of access to the newer advances is equally true.
A rebuttal often heard is that those with severe disease, with impending likelihood of morbidity and mortality, can access treatment promptly, and those with milder disease can wait for treatment. This misses two important aspects. The first is that patients may progress more rapidly than expected or disengage with care, and therefore develop significant liver disease or illness while deemed to be suitable for ‘waiting’. The second is that hepatitis C is a transmissible infection, and while someone is denied treatment it is possible that further individuals may become infected. There is therefore a different paradigm from most other disease areas — treatment for the public good and for public health.
We have the potential tools and structures to aim for elimination of hepatitis C from our populations. What we need is political will, access to the medicines, and programmes to diagnose the undiagnosed and engage the disengaged. We could then make a huge difference to our and future generations. We require the pharmaceutical companies to be more realistic in their drug costings, and more flexible systems to allow payers to commission innovatively and effectively. We could achieve elimination. What other illnesses could we say this for? We should work at realising this potential.
Chair of the British Viral Hepatitis Group and consultant in infectious diseases
North Manchester General Hospital