Erasing HCV – that will be NICE
Kate Khair writes…
Twenty-five years ago the cause of non A-non B hepatitis was discovered when HCV was identified. Since then we have cured HCV in some patients with interferon – yet another injection for those with haemophilia. While for some this has been a cure, many have been either unable to tolerate the side effects of treatment, have not lost virus during treatment or have relapsed. Now for these patients there is new hope.
New oral antivirals appear to clear HCV in as little as eight weeks in 90% of patients including those with genotype 1. Trial results announced at the International Liver Congress 2014 meeting in London, show that ABT-450/ritonavir, ombitasvir, dasabuvir, ledipasvir and sofosbuvir bring sustained clearance of HCV.
In one of the trials, a combination of ledipasvir and sofosbuvir cleared the virus in 99% of patients after 12 weeks. Even in those with cirrhotic liver disease, 24 weeks of therapy resulted in >95% success.
But at what financial cost? And can/will the NHS fund it? A 12-week regimen of sofosbuvir, just one of the medications in a proposed HCV treatment cocktail costs about £35,000. This therapy is approved for use in the UK but awaits NICE approval. While we wait patients are getting sicker with decompensating liver disease which adds additional costs to their usual bleeding management, and/or liver transplant – which of course may have the added benefit of curing haemophilia, for those who take lifelong medication to prevent rejection of the transplanted organ.
The Haemophilia CRG supports treatment of those with bleeding disorders and HCV but does not hold the budget for this new treatment. Some £17 million has been made available for treatment through the specialist infectious disease and hepatology CRGs – which means that our patients are able to access this treatment – so long as they are being seen by these services – if they are not already then maybe now is the time for change? The UK Haemophilia Society is gathering patient-based evidence to garner a funding/treatment campaign should it prove necessary.
So to WFH – just on the horizon – where this will be a major global topic of interest and no doubt there will be much enthusiastic chattering. But without appropriate funding this will remain that longed for cure that comes too late for some.
Dr Kate Khair is Nurse Consultant at Great Ormond Street Hospital, London. She is a trustee of the Haemophilia Society and sits on the Haemophilia CRG