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Health: Hepatitis C

Volume 771: debated on Thursday 28 April 2016


Asked by

To ask Her Majesty’s Government whether the funding for the new interferon-free Hepatitis C treatment will come from the National Health Service or HM Treasury.

My Lords, the funding for interferon-free hepatitis C treatment will be provided by NHS England, via its allocation from HM Treasury, as with all NHS treatments.

I thank the Minister for his Answer. I declare an interest in as much as my nephew was a haemophiliac, who died having been infected with hepatitis C. Today, I seek an assurance from the Minister that none of the £125 million—an inadequate sum—that has been promised to survivors, or families of those who were likewise infected, is used to pay for the new interferon treatment, which is a 99% cure licensed by the NHS. I want his assurance that none of that money will be used for enhanced payment and that all of it will go to support survivors or those who have been bereaved.

My Lords, I do not think I can answer that question as I do not fully understand it. Perhaps I could meet the noble Baroness outside the Chamber. All I can say is that NHS England is funding the new interferon-free treatments in accordance with the NICE technology appraisals, and is prioritising people on the basis of unmet need. I think the modelling assumption shows that 10,000 people will receive the new treatment in the coming year. I cannot answer the specifics of the noble Baroness’s question but I will follow it up outside, if I can.

My Lords, an estimated 220,000 individuals in the United Kingdom are chronically infected with hepatitis C virus. Deaths among the under-60s from end-stage liver disease and liver cancers due to the virus have doubled over the last decade. We have in the interferon-free treatment a drug that is effective in successfully treating the disease, as it reduces the viral load in 98% of patients treated to virtually zero in the whole spectrum of genome of hepatitis C virus. Therefore, it is an effective preventive drug for developing end-stage disease. It has the potential to eradicate the disease in the population. In that scenario, why would we treat only 10,000 patients per year, as the guidance says, for the next two years and not treat every patient who is a chronic carrier of hepatitis C virus?

My Lords, there is clearly a budgetary constraint. The noble Lord mentioned 220,000 people—I thought it was slightly less than that—and this drug costs many tens of thousands of pounds per treatment. Clearly, however much we would like to treat 220,000 people, it is just not feasible to do so. That is why we have NICE, which has produced its appraisals and said that, using its modelling, the number of people who need to be treated in the coming year is likely to be between 7,000 and 10,000, rising to 15,000 by 2021. However, I agree with the noble Lord that this interferon-free treatment is a massive improvement on previous treatments, with a very high cure rate.

My Lords, this is a wonderful treatment, but what has happened is blatant rationing. The Minister says that it is down to money, but something has long puzzled me. The Government reached a five-year agreement with the pharmaceutical industry that any additional costs over a baseline plus inflation would be refunded by the industry and, every quarter, his department gets back millions of pounds from the drugs industry. So can he tell me why arbitrary limits are being placed at local level on the provision of new drugs? What is happening to that rebate money? Is it in fact going back to the Treasury and not the NHS? It is quite unnecessary for there to be this rationing.

I feel almost as if we are living on a different planet—of course there are going to be budgetary constraints. Some of these new drugs are hugely expensive. We have a good scheme—the PPRS scheme that the noble Lord referred to—which enables us to get rebates from big pharma, but some of these new drugs are extremely expensive. I cannot say what the exact cost is of this interferon-free treatment for hepatitis C, but I can tell the House that it is many tens of thousands of pounds for a treatment. There are 220,000 people who could benefit from this treatment, according to the noble Lord, Lord Patel—that means many billions of pounds. If we spend many billions on this particular drug, there are many billions that we will not be able to spend on mental health or in other parts of the NHS.

My Lords, can my noble friend be kind enough to tell the House what the 200,000 people who will not receive treatment this year are expected to do, how long they are expected to wait for treatment and—bearing in mind that most or many of them will develop cirrhosis and liver cancer and go on to die—how much it will cost the taxpayer and the National Health Service to care for and treat each patient through to death? How much less is it than the cost of providing treatment today?

My Lords, there are many people who suffer from hepatitis C who are asymptomatic and do not know that they have hepatitis C, so I do not know if the figure of 220,000 is true or not. But people with it can have treatment using the drug interferon—which is an extremely unpleasant treatment that can take up to a year and has some very horrible side effects. This new drug is, in many ways, a miracle drug. It is a fantastic drug, but it is incredibly expensive. We have to accept that, not just for hepatitis C but for many cancer treatments, there are going to be some drugs that are too expensive to spend on huge numbers of people.

My Lords, if there are budgetary constraints, surely those victims who were infected by state action should have priority. Is the Minister aware that there are many Welsh patients who were infected with contaminated blood in English hospitals and are now being used in a game of pass the parcel between the UK Government and the Welsh Government? Can he say what was agreed at the meeting on 24 March between his officials and officials of the Welsh Government? Patients in Wales have not been able to get an answer from the acting Chief Medical Officer of the Welsh Government on this. Perhaps he could write to me.

My Lords, this new drug for hepatitis C is made available on the basis of clinical need, not the route of infection. There is a consultation going on about whether a special fund might be established for those who have received infected blood. I cannot answer specifically on the issue of the Welsh people but I will write to the noble Baroness on that matter.

My Lords, I declare an interest as chairman of UCLPartners and Business Ambassador for Healthcare and Life Sciences. What progress has been made on the accelerated access review, which is supposed to be able to address some of these important issues with regard to the adoption of innovation into routine practice in the NHS?

The noble Lord makes a very good point. Of course, we hope that the accelerated access review will lower the cost of some of these drugs by shortening the time it takes to approve new drugs. We hope that the accelerated access review will report within a couple of months.