Australia at risk of missing HCV elimination target

Source: PharmaDispatch. Author: Paul Cross

Around 74,000 Australians have been cured of hepatitis C through the use of the direct-acting antivirals but elimination by the target date remains in doubt given the significant decline in new patient initiations.

The latest report from the Kirby Insitute shows just 16,000 patients were initiated on the treatments in 2018, down from over 32,000 in 2016 and 21,000 in 2017.

Monthly new patient initiations in 2018 mostly ranged between 1,000 and 1,500.

The Commonwealth Chief Medical Officer Professor Brendan Murphy has previously said elimination by the target year of 2030 requires monthly new patient initiations of 1,500 to 2,000.

Importantly, according to Kirby's latest update, an annual 13,680 treatment initiations from 2019 onward are required to put Australia on track to achieve "WHO HCV elimination targets of treating 80% of people living with HCV and 80% reduction in HCV incidence by 2030."

"The treatment uptake in 2018 was slightly lower than that required," it says.

Kirby also found that 4.1 per cent of people initiated on the therapies through the PBS since they were first listed in March 2016 received more than one course. 

"DAA [direct acting antiviral] retreatment could be related to response failure to the first DAA treatment (including early treatment discontinuation), or HCV reinfection after successful treatment," it said.

In the final months of 2018, over 50 per cent of people receiving treatment were initiated on Gilead's EPCLUSA (sofosbuvir and velpatasvir), 32 per cent on AbbVie's MAVIRET (glecaprevir and pibrentasvir) and 15 per cent on other regimens.

Almost 80 per cent of people initiated on MAVIRET were prescribed an eight-week course.

The majority of patients are being initiated on treatment by a medical specialist. The proportion being initiated by general practitioners remains stuck at around 40 per cent.

According to Hepatitis Australia, only 10 per cent of general practitioners are prescribing the therapies, with around 90 per cent having 2-10 patients in their practice that could be diagnosed and cured of hepatitis C.

The Pharmaceutical Benefits Advisory Committee recently recommended a number of revisions to the PBS listing of the direct-acting antivirals with more "significant changes" on the horizon.

The recommended revisions included the removal of age restrictions on access and the removal of the remaining peg-interferon alfa-2a containing regimens.

It also recommended, "The Department investigate the feasibility of a number of other significant changes to hepatitis C listings and provide advice for consideration at a future meeting."