A press release from Public Health England notes that England will be facing 1,650 cases of decompensated cirrhosis and hepatocellular carcinoma annually, if treatment is continued at these levels.
The study estimated that the additional cost for scaling up standard treatment to 100% was £1460 million over the next 30 years (representing a 31% increase over the cost of the current rate of standard treatment and associated healthcare costs of £4680 million). In reality the costs are likely to be much higher, as the analysis examined the costs of pegylated interferon and ribavirin only, and did not consider the new oral agents (boceprevir; telaprevir; sofosbuvir).
NICE has approved boceprevir and telaprevir for use in combination with ribavirin and peginterferon alfa for the treatment of genotype 1 chronic hepatitis C infection in adults with compensated liver disease who have not been treated previously, or in whom previous treatment (e.g. with peginterferon alfa in combination with ribavirin) has failed. NHS England has issued an interim commissioning policy for sofosbuvir which will operate until the NICE technology appraisal has been published.
As well as encouraging more treatment, there is also an urgent need for better monitoring and reporting of treatment outcomes, and expansion of treatment into non-traditional settings, such as primary care, drug treatment centres, and prisons.