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THE elimination of hepatitis C as a public health threat in Australia within 10 to 15 years is now a realistic goal with four new treatments listed on the Pharmaceutical Benefits Scheme (PBS) from tomorrow, say experts.
The four drugs – sofosbuvir and ledipasvir; sofosbuvir; daclatasvir; and ribavirin – result in a cure for 90% of hepatitis C patients, are easy to administer in tablet form by GPs, have very few side effects, and need be taken for only 8 to 12 weeks in most patients.
As of 1 March, the drugs will be listed by the PBS, dramatically dropping the price to $38.30 for general patients and $6.20 for concessional patients.
Helen Tyrrell, chief executive officer of Hepatitis Australia, said the PBS listing meant “exciting times” ahead.
“There is a real opportunity here,” Ms Tyrrell told MJA InSight.
“If we can get the treatment out there, get GPs engaged, there is a real chance of eliminating hepatitis C [as a public health threat] within 10 to 15 years.”
- Related: MJA InSight — Jason Grebely & Gregory Dore: Hep C crossroads
- Related: MJA — Is the end of chronic hepatitis C virus infection in sight?
Dr Fran Bramwell, a Melbourne GP and the RACGP’s representative on an expert panel which prepared a consensus statement on the soon-to-be-published Australian Recommendations for the Management of HCV Infection, said GPs were going to be crucial in how the four newly listed drugs would make a difference.
“Those of us who’ve had previous experience with trying to get patients considered for hepatitis C treatment, and getting them through what was a very difficult treatment regimen, are very excited about this,” Dr Bramwell told MJA InSight.
“As GPs’ knowledge increases over the next 12 to 24 months, I think many more of them will become more excited as well.”
Although GPs will now be able to prescribe hepatitis C treatments for their patients without having to refer them on to a specialist, they are still required to have a brief consultation with a specialist before writing a prescription.
“That does add some time and effort for both the GPs and the specialists,” Dr Bramwell acknowledged.
Dr Cameron Loy, a Victorian GP with an interest in addiction, was quoted in Medical Republic, saying there was nothing difficult about the prescribing of the drugs.
“Every day I prescribe medications in my clinic that can cause people enormous harm, and we prescribe them safely and consider those risks,” he was reported as saying. “These aren’t hard drugs, they’re just new drugs. But it’s cookbook. It’s heavily, heavily protocol driven, like HIV medication, and it’s a skill – and knowledge – set that’s easy to acquire.”
Ms Tyrrell said a support tool for GPs was being developed to help them record patient information and history on a consultation sheet, which could then be emailed to the specialist in short order.
Additionally, Dr Bramwell said she was hopeful that over the next few months it would be possible to amend the requirements so that s 100 prescribers would be able to prescribe hepatitis C drugs without a specialist’s approval.
The Australasian Society of HIV, Viral Hepatitis and Sexual Health Medicine (ASHM) runs 2-day s 100 prescriber accreditation courses as well as 1-day hepatitis C new treatment courses.
“For high caseload GPs it will be cumbersome in the beginning,” Dr Bramwell said. “We will have to see how things develop in the next few months, but GPs have demonstrated time and time again that they are responsible about what medications they prescribe.
“Another positive about this arrangement is that it will reinforce the relationship between the GP and the specialist, and that will improve case sharing.”
The ASHM is rolling out educational material to GPs across the country, she said.
“I am very optimistic that there will be plenty of information out there for GPs,” Dr Bramwell said. “Of course the Primary Health Networks and Health Pathways are also disseminating information. There are a lot of stakeholders in this who are keen to make access to this treatment easier.”
- Related: MJA — The changing therapeutic landscape for hepatitis C
- Related: MJA — The role of general practitioners in managing and treating hepatitis C
Ms Tyrell said building GP confidence was paramount.
“Whether they’re confident with administering these drugs now or not, most of them will be wanting to know more,” she told MJA InSight.
“The model of care is being developed as we go, and our aim is for GPs to be supported. The networks [between GPs and specialists] are already established, the lines of communication are already open, we just have to make sure it works really smoothly.
“There will be teething problems, but we will get through them and GPs have a very significant part to play in that.
“We anticipate that specialists will continue to treat advanced cases in their clinics, while GPs will look after the less advanced, more routine cases where the patients are without renal damage and other comorbidities.
“These are very exciting times.”
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Good news Martin Robb. The DAAs are S85 so you won’t need to do S100 training to prescribe. All GPs can do this in consultation with Specialists.
Have lots of HepC patients Some waiting more than 2 years just to gey Hospital appointment. Keen to learn the rules and protocols and train to become s 100 prescriber.
GP who are keen to prescribe the new hepatitis C treatments should liaise with their local community pharmacy to ensure access to the drugs. Due to the expense and wholesaler conditions, pharmacies are unlikely to hold stock.
There is also a minefield of clinically important drug-drug interactions with DAAs and ribavirin. The Liverpool website and app is a great resource to help avoid treatment failure and adverse events such as myopathy and rhabdomyolysis with statin interactions.