The fear of a budget blow-out is seeing hepatitis C patients forced to wait for “miracle” drugs, at the expense of escalating liver disease rates and deaths, hepatitis experts say. Despite the Pharmaceutical Benefits Advisory Committee recommending a PBS listing for the new interferon-free drugs in March, they are still awaiting approval from the […]
The fear of a budget blow-out is seeing hepatitis C patients forced to wait for “miracle” drugs, at the expense of escalating liver disease rates and deaths, hepatitis experts say.
Despite the Pharmaceutical Benefits Advisory Committee recommending a PBS listing for the new interferon-free drugs in March, they are still awaiting approval from the cabinet eight months later.
The delay partly comes down to the government’s “laudable” aim of providing the drugs to anyone infected, regardless of injecting drug use status or severity of disease, Professor Geoff McCaughan, director of the AW Morrow Gastroenterology and Liver Center, said.
While it is unclear how many of the 1-2% of the population infected with hepatitis C will seek treatment, and its impact on PBS spending, the time had come to fund the treatments, said Professor McCaughan.
“Australia’s health system, in terms of hepatitis C therapy, is now a laughing stock in the world’s eyes.”
Research on third generation drugs is now being released, but Australian patients didn’t have access to first generation drugs, he said.
The funding push comes as four clinical trials were published in the NEJM showing the safety and efficacy of a 12-week course of a second generation drug combination of sofosbuvir and velpatasvir.
Professor McCaughan said the new breed of hepatitis C drugs were “absolutely remarkable”.
“I’ve seen people who in past would have died, rescued from the brink.”
Hepatitis Australia CEO Helen Tyrrell agreed, saying that while premature deaths due to heart disease had seen a 42% reduction between 1998 and 2011, premature deaths from hepatitis had fallen only 3% in this time.
With the newer drugs, we could see the “virtual elimination” of hepatitis C within a generation, Kevin Marriott policy officer for Hepatitis Australia said.
“The reality is that if treatment rates don’t increase, then there will be an increase in deaths,” said
“In 2014, treatment rates dropped below 1%,” said Mr Marriott, which he said is partly due to patients choosing to wait for the new breakthrough drugs that have been awaiting PBS approval early this year.
While the agreed price is still up for speculation, senate estimates put the spending on these new drugs at $1 billion or more for around 62,000 patients over the next five years, Mr Marriott said.
“This means that the price may be around $20-25,000 per treatment, one of the lowest in the developed world,” Mr Marriott said. “That’s something that the government should be commended for.”
Asking whether the PBS can find the funds is a flawed approach, he said. When liver transplants cost around $120,000, not including the follow-up costs, the spending is an investment.
Professor McCaughan told TMR he and several others were told by Gilead in September that a price had been agreed on with the government.
However, a spokesperson from the Department of Health said that negotiations are continuing, and the listing date will depend on the successful negotiations with the sponsors.
Last month the Kirby Institute released figures showing that the number of hepatitis C patients living with liver disease had more than doubled over the past decade, to almost 45,000.
NEJM 2015; online 17 November
