Hepatitis Treatment Revolution
Why insurers need to take notice of the revolution in Hepatitis treatment
28th July is World Hepatitis Day and hopefully that is the cue for insurers to take notice of the revolution that is taking place in the treatment of hepatitis and viral blood conditions generally. Moreover, the recent decision of Theresa May to order an inquiry into the contaminated blood scandal that left 2,400 people dead also reminds just how serious blood diseases are.
A 2015 study in the Lancet estimated that 143 million people globally were infected with Hepatitis C. Until recently the only treatments available were Pegylated Interferon and Ribavirin – the side effects were unpleasant and the chances of success were not that good for many of the genotypes. The new antiviral drugs such as Sofusbivir and combination drugs like Harvoni have changed things completely as they have a better than 90% success rate with no significant side effects for most people; indeed, one manufacturer AbVie claims a 99% success rate. Although there has been research 1 to suggest that the long-term effects are unproven most Hepatologists are clear that this is huge shift in treatment. Graham Foster, Professor of Hepatology at Queen Mary’s commented, "The real story is one of remarkable, if surprising, success over just a decade, transforming an unpleasant and sometimes fatal disease into one that is readily cured. 2”
The down-side is that these drugs are extremely expensive: £30,000 is usually given as the cost to the NHS but a private patient wanting to take the treatment here in the UK would end up having to pay closer to £50,000. In fact, the World Health Organisation estimates that the UK would have to spend a third of its total drugs budget just on these medicines 3 . How do we afford this and what should the role of insurers be?
First, I would argue that insurers and the insurance industry has a unique position. We intervene across the whole of the chain: we provide product insurance to the pharmaceutical companies, we provide liability cover to the doctors and we provide life and sickness cover to the individuals. This gives us a unique position to press for effective treatment of chronic conditions to be available to all. The problem is that liver disease is sometimes associated with lifestyle. The tainted blood scandal proves just how misplaced that view is. The scandal mainly affected patients with haemophilia across the UK who were given blood products by the NHS in the 1970s and 1980s. Patients were treated with clotting factor VIII imported from the USA but the products were almost certainly infected with hepatitis C and HIV and tragically 2,400 people died as a result. Hepatitis C and HIV can now be treated; without medication, they are chronic conditions that impact people’s long term ability to participate in society; they reduce their ability to contribute; and 700,000 deaths a year globally come just from hepatitis C infection. Certainly, cancer is a bigger killer but Hepatitis is a disease for which a "cure” is available now.
India has taken the radical step of allowing generic hepatitis medicines to be sold: Indians can complete a full 12-week course for a few hundred pounds, a fraction of the cost of treatment in the UK (it is worth remembering that the drugs themselves are well proven anti-virals, it is their use in combination and as a treatment for hepatitis that is new). Indeed, there are now "buyers’ clubs” that allow people in the UK to purchase drugs from India so that a full course of treatment costs around £1,000. Making generic treatments generally available is probably a step too far here in the UK but there are things that we can do:
- First, as insurers we should allow the cost of drugs bought through a buyers’ club to be fully reimbursed.
- Second, we should continue to develop a sensitive approach to illnesses that affect some groups more than others and recognise that illness can affect anyone.
- Third, we should push for treatment for chronic conditions that affect quality of life as well as life expectancy to be available on the NHS. We should also do everything we can to promote awareness and understanding.
- Finally, we should recognise that Hepatitis is now, to all intents and purposes, curable and should reflect that in our health assessments and in the premiums we charge.
Here at Pulse we cannot change the world straight away but we believe that because we consider applications from people with many chronic conditions every day we are able to look at each case on its merits including people with hepatitis or other blood diseases,
Remember, "When the computer says no! Talk to Pulse.”
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