NHS could save £200 million by treating hepatitis C in London

New report stresses the need for integrated, patient-centred services to tackle inequality in the capital.

A public health report shows that treating just 10% of people with hepatitis C could save £200 million in London alone.  The Public Health Report on Commissioning of Hepatitis C Services in London for People who Inject Drugs reports that currently less than 4 % of people with the hepatitis C virus in England are treated each year. Only one in three London boroughs has a treatment pathway in place and fewer still actively monitor the numbers of patients progressing through this pathway.

The report was commissioned by the London Joint Working Group for Substance Misuse and Hepatitis  (LJWG). The LJWG Chair, Professor David Nutt, from Imperial College, London, explains why the report is so important.

“In London, rates of hepatitis C are higher than elsewhere in England. The population most commonly affected are people with a history of injecting drugs, and these people can have complex needs, and find it difficult to navigate traditional services, which are often complicated by multiple appointments in different locations.”

Professor Steve Field, Deputy National Medical Director for Health Inequalities agrees that this report is a call to action for the NHS.

“Chronic hepatitis C infection in people who inject drugs represents a major health inequality in a marginalised group. It is clear that a ‘one-size fits all’ approach is not applicable in London. This report argues for the cost-effectiveness of treating hepatitis C-related liver disease.”

Hepatitis C is responsible for a third of all deaths from liver disease, and all the available evidence points to it being more cost-effective to treat the virus than to manage the effects of liver disease progression. Failing to act now could cost the NHS at least £200 million over a lifetime.

Liver disease is on the increase in England, while deaths from other causes continue to decline. In her first annual report, the Chief Medical Officer, Professor Dame Sally Davies highlighted the need to tackle liver disease as a priority, pointing out that “between 2000 and 2009, deaths from chronic liver disease and cirrhosis in the under 65s increased by around 20% while they fell by the same amount in most EU countries. And all 3 major causes of liver disease – obesity, undiagnosed infection [including hepatitis C], and, increasingly, harmful drinking – are preventable.”

The report recommends that, to enable people to access hepatitis C treatment more easily, the number of appointments needs to be reduced, and the patient pathway needs to be clear and actively monitored by commissioners. There are some examples of good joined-up services in London, but these need to be emulated across the capital, to ensure equity of access to good quality care for all. Innovative services in Lambeth and Tower Hamlets have set up hepatitis clinics located in the drug treatment service to make it easier for patients to access treatment and support. Commissioners need to embed awareness raising campaigns and a multi-component prevention strategy as part of all programmes. Additionally, they should consider locating needle and syringe exchanges in pharmacies, and look at the role of dry blood spot testing, which can increase the availability of tests.

Earlier diagnosis and treatment will not only treat those who have existing chronic hepatitis C infection, but will also prevent the spread of the virus. This will result in long term savings – both in terms of patient welfare and reducing the financial burden.

The Public Health Report on Commissioning of Hepatitis C Services in London for People who Inject Drugs is published today in the Health Service Journal.

on what strain of the virus they have.

  • Treatment with current anti-viral drugs can last from 24 to 72 weeks depending on the type of virus.
  • Treatment can be challenging, so it’s important that treatment is a collaboration between the patient and the specialist nurses and doctors, and key workers

For more information about Hepatitis C, see www.hepctrust.org.uk