NHS England’s decision to cap access to National Institute for Health and Care Excellence (NICE) approved hepatitis C treatments has been attributed to their cost. These antiviral medicines have led to vast costs for national healthcare systems and huge profits for the pharmaceutical industry. So it is understandable that the mainstream media and general public assume that the cost to the NHS (either per patient or in absolute terms) is prohibitive.
In the absence of any other guide, the assumption is all too often being made that the list price for the treatments represents the actual cost to the NHS, therefore we have seen media reports of these treatments costing as much as £120,000 per patient. Although the price the NHS pays is confidential, unusually, in this case, we know that the NHS expects to treat 10,011 patients in 2016–2017 at a cost of £190m. Therefore, the average cost per patient will be under £20,000.
This is not an exceptional amount of money to treat a patient with a potentially life threatening condition – the average annual cost of NHS cancer treatment per patient is slightly more than this. It is worth remembering that these hepatitis C treatments are curative and, unless somebody is re-infected, represent a one-off cost.
The key driver of overall spending on these treatments is the prevalence of hepatitis C. Thanks in large part to the work since the 1980s of drug services providing needle and syringe programmes, we have much lower prevalence of hepatitis C in the UK than many other high income countries.
The health system in the United States, for example, faces treating somewhere between 2.7 million and 3.9 million people with chronic hepatitis C, representing as much as 1% of the population, whereas the UK prevalence is thought to be 0.4% of the population. According to the World Health Organization (WHO), there are fewer than 165,000 people with hepatitis C in England, of which around 90,000 are already diagnosed. Fewer than 30,000 people are estimated to be in touch with the NHS treatment pathway, and only a proportion of them will require treatment in 2016–2017.
In addition, a large number have been left with only limited access to the interferon-free treatments, with none of the new treatments having been fully approved by NICE for the large group of patients who are living with genotypes 2 and 3 of the virus.
One leading clinician has estimated that, without the cap to hepatitis C treatment, there would only be around 15,000 patients seeking treatment. Therefore an increase of £100m in spending on hepatitis C would allow NHS England to treat these people and avoid the cap. Compare this with the annual spend in England for HIV medicines, which must easily exceed £500m.
If the costs for hepatitis C treatment are not exceptional, then why is NHS England treating people living with hepatitis C exceptionally?
The Hepatitis C Trust