Focus on primary care before we run out of hep C patients, says Ed Gane

The health sector could run out of hepatitis C patients to treat unless GPs and primary care connect with thousands of untreated people in the community, Auckland hepatologist Ed Gane says.

Since direct-acting antiviral drug Viekira Pak was funded in July last year, successful treatment of hepatitis C has had a huge upsurge, with more than 2000 patients being cured, Professor Gane says.

But the flow of easy-to-reach patients, treated mainly in hospital clinics, is coming to an end. The pressing need is to engage with the 48,000 patients believed to be in the community, he says.

Treatment rate plateauing.

Until March, between 150 and 200 patients were being treated each month, but the number is now about 105.

“We wouldn’t expect that to be happening so soon,” Professor Gane says. “We would have expected it to remain high, or increase.”

The chief hepatologist at the New Zealand Liver Transplant Unit, he says the focus on treatment has been through hospitals, and this needs to change. Prescribing of Viekira Pak has been available in general practice since October.

Hospital clinics have emptied their waiting lists, and could run out of patients to treat: “I feel there’s a lack of community engagement. We need to be getting the message out that this is a disease that should be treated outside hospital.”

Wide variation in primary care treatment

Professor Gane says the proportion of hepatitis C patients being treated in primary care varies widely across DHBs. In Northland, it is up to 70 per cent, in Auckland, 60 per cent and Bay of Plenty, 50 per cent. Elsewhere, figures are much lower, with some down to 5 per cent.

Ministry of Health national manager for long term conditions Karen Evison says the ministry will continue to work with DHBs to raise awareness, improve primary healthcare access and increase the number of people being diagnosed with hepatitis C.

Ms Evison expects to confirm any day now the number of people funded for the new treatments. “It is too early to say whether there has been a plateau or a decline,” she said earlier this month.

Work & Income has this month begun support to improve access to treatment in the community, including for released prison inmates.

“People seeking hepatitis C treatment in the community from their GP, who would qualify for a Community Services Card, may be eligible for a Special Needs Grant to cover the costs of transport, prescription costs and three or four doctor visits, as required.”

Urgent need for funded pan-genotypic drug

Professor Gane says the next breakthrough will be funding a drug to treat pan-genotypic hepatitis C. Viekira Pak is effective against genotype 1 only, or about 55 per cent of patients.

The other 45 per cent have a tougher time accessing treatment, and may need to use the Australian-based FixHepC Buyers’ Club to access affordable generics.

Pharmac and its Pharmacology and Therapeutics Advisory Committee are assessing two pan-genotypic drugs.

“We are very, very hopeful one will be funded within the next six to 12 months.”

Source: https://www.nzdoctor.co.nz/login.aspx?ReturnUrl=/news/2017/august-2017/09/focus-on-primary-care-before-we-run-out-of-hep-c-patients,-says-ed-gane.aspx&returnid=84770

Cliff Taylor
ctaylor@nzdoctor.co.nz
Wednesday 09 August 2017, 11:00AM

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