provided by NHS England show that the entire system of 22 'operational delivery networks' in England will be permitted to treat fewer
people in a three-month period than Australian GPs started on treatment in
two weeks in March 2016. In March 2016, at least 1811 people
began treatment for hepatitis C in Australia, compared to 2790 in the whole of
2014, according to figures released by the Kirby Institute. NHS England plans to provide treatment for 2000 people with hepatitis C
from April to June 2016, with slight increases in subsequent quarters.
Approximately 160,000 people in England are estimated to have hepatitis C.
In comparison the Scottish government plans to treat 1500 people each year
up to 2020, out of an estimated infected population of 37,000.
NHS England says that the majority of 5000 people with hepatitis C and
cirrhosis have now been cured, and that NICE recognised in its guidance that
treatment for all would take several years. However, as Professor
Antonio Craxi observed at the International Liver Congress, the progression of
fibrosis is unpredictable. Clinicians are being forced to make individual
decisions about which people to treat first based on fibrosis staging, leading to disappointment and
frustration for many.
“People have been waiting years for these drugs because they felt what was
on offer before was too toxic,” said Samantha May, the Hepatitis C Trust’s
Support Services Manager, in a press statement on the decision to seek judicial
review. “Now suddenly to be told they may have to wait months, even years more
is really distressing. Our helpline is overwhelmed with people who cannot
understand why NICE says they can be treated now but their hospitals are
sending them away and telling them they’ll get a letter at some point in the
The list price of the 8-week course of treatment with Harvoni
approved by NICE for people with genotype 1 is £25,986.66, almost three times
higher than the potential volume-based treatment price negotiated in Australia,
a country with almost 30% higher GDP per capita than the United Kingdom. (Drug
prices are negotiated country-by-country with reference to GDP per capita.)
What discounts NHS England may have negotiated on listed drug prices have
not been made public, but the £200 million annual envelope for hepatitis C
treatment funding implies that if treatment is rationed to 10,000 people each
year, the average price of treatment in England is around £20,000 per treatment