Power to the People – A Case Study on Hep C Treatment Access

By Libhan Collins, Key Correspondent for the Irish Forum for Global Health

Hepatitis C (HCV) is a viral infection, transmitted via blood-to-blood contact, that targets the liver. In chronic cases, it can cause life threatening complications over time such as cirrhosis and it typically increases the likelihood of developing liver cancer.

It is estimated that in Ireland there are between 20,000 and 30,000 people who suffer from a chronic form of the disease, with hundreds of new cases annually. Speaking at the 3rd annual Access to Medicines Conference about the work of the HSE, under her direction, Michele Tait took delegates through the challenges related to the lack of access for effective treatments for this devastating illness.

Attempts to eradicate HCV in Ireland – A Case Study

In 2012, there remained no national programme and very limited policy regarding the management of HCV in Ireland. Treatments that were available had poor outcomes and people suffering from HCV were not given adequate support. Tait affirmed that the time had come to put the patient first by the time she had been appointed to lead the programme. With the help of advocacy groups and pressure from patients, the government took action and a commissioned a report outlining a multi-annual treatment plan, paving the way for improvements in Ireland’s approach to treating HCV patients.

In the coming years there was a transformation in treatments available for those suffering from HCV most notable, Interferon 3. A National Programme was established, which Michele led until recently, and feasibility studies were carried out. The overall goal of the programme was to eradicate HCV from the Irish population despite the high cost of the drugs.

The government established a cap of €30 million per annuum to be allocated to the National Hepatitis C Treatment Programme. This meant that less than 350 patients would get treated annually. Drugs were being rationed, being offered to those who were in the worst stages of the condition. This had the adverse impact of allowing those who had a less progressed stage of the disease to deteriorate while waiting for treatment. It was a major challenge that Michele and her team on the programme were determined to overcome, she explained.

In 2015, it was costing sufferers of the disease €90,000 for a 12-week course of treatment. This was frustrating as not all patients were responding well to the treatment, some requiring 24 weeks of treatment before reaping the benefits. In their estimates, it became apparent to the HSE that it was going to cost €3 billion to treat all Irish patients with no guarantee of efficacy at 12 weeks. This was not a possibility. Michele and her team were faced with an overwhelming financial barrier. The National Hepatitis C Treatment Programme met with six of the suppliers and put pressure on them to negotiate a better deal. The HSE then committed to treating a minimum of patients at a lower cost of the drug. Unfortunately, different drugs worked better with different genotype variants of the virus. This meant that the strain of virus affecting patients could vary greatly and impact on the cost of their treatment.

In 2017, the national programme could not keep up with the costs and decided to take another approach. Pitting the suppliers against each other, they proposed that they would only offer the best value priced drug to patients in Ireland. Prices were now comparative with those paid by governments in other EU countries. This move gave the National Hepatitis C Treatment Programme more control of the situation, leading to a better deal for patients, and an increasing number of patients being treated each year: in 2015, 350 were treated and in 2018, that figure rose to 1,700.
In addition, more rewards were reaped as HCV became eradicated among Irish patients who had haemophilia in 2016. By 2017, all who had contracted HCV through blood products had been given treatment. Moreover, all of this progress was achieved within the €30 million government budget.

Michele emphasised that there are instruments available to the government and national health services to improve access to medicine and reduce the costs of drugs. Progression over time and constant review of contracts can make way for further reductions in cost. The HSE engagement with suppliers lifted restrictions on patients and shifted the paradigm of power out of the hands of the drug companies. Ultimately it was the hard work of advocates and the passion of those involved in the national programme to secure fair pricing for patients and return the power to the people.