why is hcv medication not available to all?
TRANSCRIPT
DR SAM BHIMAGP SUBSTANCE MISUSE SPECIALISTLONDON & ESSEX, U.K.
WHY IS HCV MEDICATION NOT AVAILABLE TO ALL?
2ND OCTOBER 2016
• Worldwide 130-150m chronically infected, 15-30% cirrhotic
Predominantly Africa, Central & East Asia
700,000 deaths per year
Most transmission through injecting drug use, unsterile medical equipment, blood products
CONTEXT
• UK prevalence 214,000 (0.3% popn) in 201550-80% of PWID, most due to lack of
access to clean equipmentUS prevalence 3.4m (1% popn)Awareness of diagnosis generally low
(15-45% in US, 35-50% in UK)High risk groups
PWID, offender, Asian origin population
CONTEXT
• Testing rates vary widely (8% in UK prisons, up to 80% in drug services)
Treatment rates low
UK: 60-70% currently infected attend specialist service
18% treated but can be as low as 1-2%
CONTEXT
• New, nationally-approved treatments
Radically different (better) regimes
Better cure rates
SERIOUSLY…. WHAT’S THE PROBLEM?
WHY NOT TREAT EVERYONE?
• Stigma
Genotype (new treatments for 1 and 3 only)
Geographical lack of access
‘Hierarchy of need’
PATIENT FACTORS
• Stigma
Lack of funding
‘Hierarchy of needs’ with high cost of treatment
SOCIETAL AND HEALTH SERVICE FACTORS
• Not quite universal…
Stage 2 and beyond (230,000 eligible) from Sept 2016
Deal between government and Gilead
€41,000 per 12 week course v €75,000 in U.S.
FRANCE - UNIVERSAL ACCESS
• Patent ‘battle’ between Gilead and patent office
Generic courses available for ~$400 via licensing of drugs
Epclusa (pan-genotype) may become available via generic manufacturers
INDIA - INCREASED ACCESS
• Complex approval system and allocation of funding to ODNs
Working back from most unwell to least affected (waiting times if high numbers)
£200m budget for 10,000 treatment episodes (capped per month)
Incentives for further treatments up to £70m - 85% retested 1 yr, 90% to be treated
Treatment can be administered from any suitable centre
U.K. - IMPROVING ACCESS
• Useful emerging data due to targets
treatment failure lower where NEx available
infrastructure for delivery needs improvement
exposes differences in drug service quality
different populations treated across country with incentive scheme
U.K. - IMPROVING ACCESS
• Govts / patent offices to work with pharma on price (India and France examples)
Patients must be engaged (5x bigger popn than HIV) - media, celebs, normalise condition, primary care
Hepatology or drug problem? Who leads to get patients into treatment?
WORK TO DO