Hepatitis C can and should be treated early in India and new research shows how cost effective this is. Generic drugs for treating hepatitis C manufactured in India cost just $300 or approximately Rs 19,000 for a complete three-month course of the three drugs sofosbuvir, ledipasvir and daclatasvir. In the United States, the same treatment costs nearly $65,000. The costs in India reduce even further if government bodies purchase the drugs in bulk.
Hepatitis C is a blood-borne viral disease that can be either acute or chronic. An illness from the infection can last a few weeks or can be a lifelong affliction. The disease is transmitted through exposure to small quantities of blood as in through shared injection drug use, unsterilised medical equipment and transfusion of unscreened blood. It also can be transmitted sexually or from an infected mother to her baby. Those with a chronic infection may develop liver cirrhosis or liver cancer in the long run.
According to the World Health Organisation, India is has a burden of at least six million chronically infected hepatitis C patients. An estimated 59,000 deaths occurred from the disease in India in 2015.
A study published on Wednesday in the journal PLOS One shows that providing early treatment not only saved lives, it increased life expectancy by eight years and reduced lifetime health costs by $1,309 per person treated. The treatment became cost-effective within two years, the study said.
Complications of not treating hepatitis C include liver cirrhosis, or scarring of the liver. Some patients also develop liver cancer and may need liver transplantation. The treatment for these complications are difficult and may cost many lakhs of rupees.
“Running a programme for hepatitis C will only be beneficial to the government in the long run,” said Dr Rakesh Aggarwal, one of the authors from the gastroenterology department at Lucknow’s Sanjay Gandhi Postgraduate Institute of Medical Sciences. “Despite the drugs being cheaper in India, a lot of people do not take treatment. Some are not able to afford treatment. Some do not understand the implications of not taking treatment. We need to make them understand that it is only beneficial in the long run to take treatment.”
The Punjab model
In 2016, the National Pharmaceutical Pricing Authority capped the price of sofosbuvir, the major drug used to treat hepatitis C to Rs 619 per tablet.
The Punjab government is the only state government that provides treatment for people living with hepatitis C free of cost in all its 22 district hospitals and three medical colleges.
“We showed that the effectiveness of treatment with generic drugs is 95%,” said Dr RK Dhiman, from the department of hepatology at the Postgraduate Institute of Medical Education and Research, Chandigarh. Dhiman said that the Punjab government procures the drug for one-third the cost – at only $110 for the three-month course.
The costs of diagnosis of the disease is high at around Rs 3,000 compared to diagnosis of other diseases. “We are trying to bring down the cost of the diagnostics to $6 to $10 (Rs 400 to Rs 650),” said Dr Dhiman.
The WHO advises testing of high risk patients such as injectable narcotic drug users, people who are sexual partners of hepatitis C infected patients, people living with HIV, prisoners and people who have tattoos or piercings for the disease.
Haryana provides free treatment for hepatitis C infected people living below the poverty line at Rohtak’s Postgraduate Institute of Medical Education. In Manipur, patients can apply for reimbursement for hepatitis C treatment. In Mizoram, hospitals empanelled under the Mizoram State Health Care Scheme provide treatment under the state insurance scheme.
Scale up treatment
“The study makes a compelling case for a public health programme to scale up hepatitis C treatment with generic direct acting antivirals in India,” said Leena Menghaney, from Médecins Sans Frontières’s Access Campaign. Direct acting antivirals like sofosbuvir target specific proteins in the hepatitis C virus and disrupt its replication and infection.
“In the absence of a public health approach from the Indian health ministry to scale up prevention, testing and treatment to those most at risk of Hepatitis C infection, we will not see major public health benefits and new infections will continue to rise despite the availability of affordable generic hepatitis C medicines in the private sector,” Menghaney added.
Loon Gangte, South Asia regional coordinator for the International Treatment Preparedness Coalition who works on advocacy for treatment of hepatitis C, said that despite the costs of treatment going down, the Indian government has not shown much interest in providing treatment.
“We do not even have national data for hepatitis C, let alone a programme,” said Gangte. “If the Government of India buys the medicines, it will be much cheaper. But there is no political will.”