To ask the Secretary of State for Health what the (a) primary diagnosis count and (b) all diagnosis count of finished consultant episodes for all hepatitis B-related conditions was in each year since 1997-98 for all (i) inpatients and (ii) outpatients as recorded by the Hospital Episodes Statistics database, broken down by primary care trust area; and which hepatitis B-related 4-character diagnosis codes are covered by the Hospital Episodes Statistics database. (222420)

The information requested for in-patients has been placed in the Library, for years 1997-98 to 2006-07. However, outpatient data are not included as clinical coding is not mandatory for the out-patients dataset and coverage is very low.

To ask the Secretary of State for Health how many notifications of hepatitis B have been made to the Health Protection Agency and its predecessor bodies; and what estimate he has made of the overall prevalence of hepatitis B (a) in England in total and (b) in each primary care trust area in each year since 1997. (222421)

The information requested about notifications of hepatitis B is shown in the following table.

The Department estimates that about 0.3 per cent. of the United Kingdom population is chronically infected with hepatitis B virus (about 180,000 people)². Estimates of hepatitis B prevalence at primary care trust level are not available.

To ask the Secretary of State for Health what guidance his Department (a) has issued and (b) plans to issue to primary care trusts regarding the management of hepatitis B services. (222422)

The Department has issued a number of guidance documents to the national health service about hepatitis B services. Copies have been placed in the Library and are also available on the following websites:

Department of Health:

Addendum to HSG (93)40: Protecting healthcare workers and patients from hepatitis B—EL (96)77(1996)

(www.dh.gov.uk/en/PublicationsAndStatistics/LettersAndCirculars/ExecutiveLetters/DH_4088385);

Children in need and bloodborne viruses: HIV and hepatitis (January 2002)

(www.dh.gov.uk/en/Consultations/Closedconsultations/DH_4073041);

Good practice guidelines for renal dialysis/transplantation units: prevention and control of blood-borne virus infection (September 2002)

(www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_4005752);

Guidance for clinical healthcare workers: protection against infection with blood-borne viruses (April 1998)

(www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_4002766);

Health clearance for tuberculosis, hepatitis B, hepatitis C and HIV: new healthcare workers (March 2007)

(www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_073132)

Hepatitis B infected health care workers and antiviral therapy (March 2007)

(www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_073164);

Hepatitis B infected healthcare workers: Guidance on implementation of Health Service Circular 2000/020 (June 2000)

(www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_4008156);

Hepatitis B immunisation of homosexual and bisexual men attending GUM clinics: provision of extra vaccine (June 2002)

(www.dh.gov.uk/en/Publicationsandstatistics/Lettersandcirculars/Dearcolleagueletters/DH_4010113);

HSC 1998/127: Screening of pregnant women for hepatitis B and immunisation of babies at risk (July 1998)

(www.dh.gov.uk/en/Publicationsandstatistics/Lettersandcirculars/Healthservicecirculars/DH_4004295)

Immunisation against infectious disease—The Green Book (includes a chapter on hepatitis B) (October 2007)

(www.dh.gov.uk/en/Publichealth/Healthprotection/Immunisation/Greenbook/dh_4097254);

Information for midwives: hepatitis B testing in pregnancy (January 2002)

(www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_4007742);

Screening for infectious diseases in pregnancy: Standards to support the UK antenatal screening programme (August 2003)

(www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_4050934); and

The national strategy for sexual health and HIV—Implementation action plan (June 2002)

(www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_4006374).

Connecting for Health:

Extending the childhood immunisation data collected through the COVER (cover of vaccination evaluated rapidly) system by the Health Protection Agency: uptake of hepatitis B immunisation in babies born to infected mothers (DSC Notice 25/2004) (November 2004)

(www.connectingforhealth.nhs.uk/dscn/dscn2004/252004.pdf);

National Treatment Agency for Substance Misuse:

Drug misuse and dependence: UK guidelines on clinical management (includes advice about hepatitis B) (September 2007)

(www.nta.nhs.uk/publications/documents/clinical_guidelines_2007.pdf).

The National Institute for Health and Clinical Excellence has published technology appraisal (TA) guidance on the treatment of chronic hepatitis B (TA 96, TA 153 and TA 154).

The Department is not currently planning further guidance to the NHS about hepatitis B but keeps this under review, including in the light of advice from its expert scientific advisory committees, the Advisory Group on Hepatitis and the Joint Committee on Vaccination and Immunisation.

To ask the Secretary of State for Health what (a) technology appraisals, (b) interventional guidelines, (c) clinical guidelines and (d) public health guidelines which have an effect on hepatitis B services are issued by the National Institute for Health and Clinical Excellence (NICE); what effect each has on hepatitis B; on what date each was issued; which workstreams under consideration by NICE have an effect on hepatitis B services; and if he will make a statement. (222423)

The following technology appraisals have been issued by National Institute for Health and Clinical Service (NICE):

“Adefovir dipivoxil and pegylated interferon alpha-2a for the treatment of chronic hepatitis B” (22 February 2006).

“Entecavir for the treatment of hepatitis B” (27 August 2008)

“Telbivudine for the treatment of chronic hepatitis B” (27 August 2008)

Copies of the technology appraisals have been placed in the Library and are available on NICE’s website at:

www.nice.org.uk/Guidance/TA96/QuickRefGuide/pdf/English,

www.nice.org.uk/Guidance/TA153/Guidance/pdf/English and

www.nice.org.uk/Guidance/TA154/QuickRefGuide/pdf/English.

A technology appraisal on tenofovir disoproxii fumarate for the treatment of hepatitis B will be published in May 2009. It was formally referred to NICE’s workstream to appraise its clinical and cost effectiveness.

There are no published clinical guidelines or guidelines in development that directly address the management of hepatitis B services. However, “Drug Misuse, psychological interventions” (July 2007) addresses the need for those who misuse drugs to reduce their exposure to blood-borne viruses where hepatitis B testing is recommended. A copy of this guidance has been placed in the Library and is available on NICE’s website at:

www.nice.org.uk/nicemedia/pdf/CG051NICEguideline2.pdf

NICE is currently preparing the following public health guidelines, which are relevant to hepatitis B services:

“Needle and syringe programmes: providing injecting equipment to people who will inject drugs” (to be published in February 2009)

“Guidance on differences in the uptake of immunisations (including targeted vaccines) in people younger than 19” (to be published in June 2009)

There are no relevant interventional guidelines, which will have an effect on hepatitis B services.

These technology appraisal and guidelines for those involved in the management of hepatitis B services will promote good practice in the treatment and prevention of hepatitis B infection.

To ask the Secretary of State for Health how many drugs were dispensed for the treatment of hepatitis B in each year since 1997, broken down by primary care trust area; and what the net ingredient cost of the drugs was in each year. (222424)

A significant number of primary care trusts dispensed less that 50 items each year in the community, in England. Releasing actual figures may potentially allow the identification of individual patients. Below are national dispensing figures with net ingredient cost (NIC).