A steady decline in the uptake of new highly effective hepatitis C medications since they were subsidised 16 months ago has public health researchers and clinicians concerned for the health and well-being of the estimated 150,000 Australians still living with hepatitis C infection.
According to Pharmaceutical Benefits Scheme (PBS) data, the number of prescriptions issued in Australia has progressively fallen each month following an initial spike after March 2016 when the PBS listed the treatments, which have a cure rate of more than 90 percent.
From a peak in June 2016 when there were approximately 13,500 people on the new drugs, numbers have declined every month since to 6,300 in February 2017, the latest available monthly figures.
The PBS data shows that up to 40,000 people in total were treated in the first 12 months of subsidised medications of the more than 200,000 Australians infected with hepatitis C.
Infectious diseases physician and Burnet Institute Deputy Program Director (Disease Elimination) Dr Joseph Doyle, said the strong early interest was expected, but tens of thousands are now missing out on the prospect of a cure for the virus, which kills 700 Australians each year.
“The key worry about the data is that it shows we are treating fewer people, yet the treatment is so simple, just one pill a day for 12 weeks,” Dr Doyle said.
“The people in the first wave of treatment uptake were motivated and ready, but now we need to encourage and facilitate and make it as easy as possible for people living with hepatitis C to get onto treatment.
“Most of these people probably know that they’re infected, but there’s a sizeable minority who won’t have been tested recently, so it’s not front of mind, or they may never have been tested, or might have recently acquired it."
Dr Doyle said these people are at high risk of serious illness from hepatitis C, which generally shows no symptoms until it’s too late.
A person infected with the virus for 20 years will likely have some liver damage, which can progress to cirrhosis, then liver cancer and liver failure, which can only be treated with a liver transplant.
Dr Doyle said the key to meeting the World Health Organization target of hepatitis C elimination in Australia by 2030 is to treat the people most at risk of transmission and reinfection, including people who inject drugs, and gay and bisexual men with HIV.
“It’s vital that we continue to encourage people to get tested and onto treatment, and restore the momentum that we achieved in the first six months,” Dr Doyle said.
“The quicker we treat people, the quicker we will get to these elimination targets and the cheaper it will be for society.
“The slower the pace of treatment, the more likely it is that people will become re-infected, more people can transmit hep C, and we delay the conclusion of the problem.
“We need people to be treated as soon as they are positive; and for people who have been positive for a long time, we need to leverage all of the health services, not just hospitals and specialists, but bring GPs into the fold to get people tested and treated.”