Treating hepatitis C early saves money, says study. Now, for the political will

Cost of treatment for hepatitis C with generic drugs in India is much cheaper than in Europe or United States.

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.”

We welcome your comments at
Sponsored Content BY 

What hospitals can do to drive entrepreneurship and enhance patient experience

Hospitals can perform better by partnering with entrepreneurs and encouraging a culture of intrapreneurship focused on customer centricity.

At the Emory University Hospital in Atlanta, visitors don’t have to worry about navigating their way across the complex hospital premises. All they need to do is download wayfinding tools from the installed digital signage onto their smartphone and get step by step directions. Other hospitals have digital signage in surgical waiting rooms that share surgery updates with the anxious families waiting outside, or offer general information to visitors in waiting rooms. Many others use digital registration tools to reduce check-in time or have Smart TVs in patient rooms that serve educational and anxiety alleviating content.

Most of these tech enabled solutions have emerged as hospitals look for better ways to enhance patient experience – one of the top criteria in evaluating hospital performance. Patient experience accounts for 25% of a hospital’s Value-Based Purchasing (VBP) score as per the US government’s Centres for Medicare and Mediaid Services (CMS) programme. As a Mckinsey report says, hospitals need to break down a patient’s journey into various aspects, clinical and non-clinical, and seek ways of improving every touch point in the journey. As hospitals also need to focus on delivering quality healthcare, they are increasingly collaborating with entrepreneurs who offer such patient centric solutions or encouraging innovative intrapreneurship within the organization.

At the Hospital Leadership Summit hosted by Abbott, some of the speakers from diverse industry backgrounds brought up the role of entrepreneurship in order to deliver on patient experience.

Getting the best from collaborations

Speakers such as Dr Naresh Trehan, Chairman and Managing Director - Medanta Hospitals, and Meena Ganesh, CEO and MD - Portea Medical, who spoke at the panel discussion on “Are we fit for the world of new consumers?”, highlighted the importance of collaborating with entrepreneurs to fill the gaps in the patient experience eco system. As Dr Trehan says, “As healthcare service providers we are too steeped in our own work. So even though we may realize there are gaps in customer experience delivery, we don’t want to get distracted from our core job, which is healthcare delivery. We would rather leave the job of filling those gaps to an outsider who can do it well.”

Meena Ganesh shares a similar view when she says that entrepreneurs offer an outsider’s fresh perspective on the existing gaps in healthcare. They are therefore better equipped to offer disruptive technology solutions that put the customer right at the center. Her own venture, Portea Medical, was born out of a need in the hitherto unaddressed area of patient experience – quality home care.

There are enough examples of hospitals that have gained significantly by partnering with or investing in such ventures. For example, the Children’s Medical Centre in Dallas actively invests in tech startups to offer better care to its patients. One such startup produces sensors smaller than a grain of sand, that can be embedded in pills to alert caregivers if a medication has been taken or not. Another app delivers care givers at customers’ door step for check-ups. Providence St Joseph’s Health, that has medical centres across the U.S., has invested in a range of startups that address different patient needs – from patient feedback and wearable monitoring devices to remote video interpretation and surgical blood loss monitoring. UNC Hospital in North Carolina uses a change management platform developed by a startup in order to improve patient experience at its Emergency and Dermatology departments. The platform essentially comes with a friendly and non-intrusive way to gather patient feedback.

When intrapreneurship can lead to patient centric innovation

Hospitals can also encourage a culture of intrapreneurship within the organization. According to Meena Ganesh, this would mean building a ‘listening organization’ because as she says, listening and being open to new ideas leads to innovation. Santosh Desai, MD& CEO - Future Brands Ltd, who was also part of the panel discussion, feels that most innovations are a result of looking at “large cultural shifts, outside the frame of narrow business”. So hospitals will need to encourage enterprising professionals in the organization to observe behavior trends as part of the ideation process. Also, as Dr Ram Narain, Executive Director, Kokilaben Dhirubhai Ambani Hospital, points out, they will need to tell the employees who have the potential to drive innovative initiatives, “Do not fail, but if you fail, we still back you.” Innovative companies such as Google actively follow this practice, allowing employees to pick projects they are passionate about and work on them to deliver fresh solutions.

Realizing the need to encourage new ideas among employees to enhance patient experience, many healthcare enterprises are instituting innovative strategies. Henry Ford System, for example, began a system of rewarding great employee ideas. One internal contest was around clinical applications for wearable technology. The incentive was particularly attractive – a cash prize of $ 10,000 to the winners. Not surprisingly, the employees came up with some very innovative ideas that included: a system to record mobility of acute care patients through wearable trackers, health reminder system for elderly patients and mobile game interface with activity trackers to encourage children towards exercising. The employees admitted later that the exercise was so interesting that they would have participated in it even without a cash prize incentive.

Another example is Penn Medicine in Philadelphia which launched an ‘innovation tournament’ across the organization as part of its efforts to improve patient care. Participants worked with professors from Wharton Business School to prepare for the ideas challenge. More than 1,750 ideas were submitted by 1,400 participants, out of which 10 were selected. The focus was on getting ideas around the front end and some of the submitted ideas included:

  • Check-out management: Exclusive waiting rooms with TV, Internet and other facilities for patients waiting to be discharged so as to reduce space congestion and make their waiting time more comfortable.
  • Space for emotional privacy: An exclusive and friendly space for individuals and families to mourn the loss of dear ones in private.
  • Online patient organizer: A web based app that helps first time patients prepare better for their appointment by providing check lists for documents, medicines, etc to be carried and giving information regarding the hospital navigation, the consulting doctor etc.
  • Help for non-English speakers: Iconography cards to help non-English speaking patients express themselves and seek help in case of emergencies or other situations.

As Arlen Meyers, MD, President and CEO of the Society of Physician Entrepreneurs, says in a report, although many good ideas come from the front line, physicians must also be encouraged to think innovatively about patient experience. An academic study also builds a strong case to encourage intrapreneurship among nurses. Given they comprise a large part of the front-line staff for healthcare delivery, nurses should also be given the freedom to create and design innovative systems for improving patient experience.

According to a Harvard Business Review article quoted in a university study, employees who have the potential to be intrapreneurs, show some marked characteristics. These include a sense of ownership, perseverance, emotional intelligence and the ability to look at the big picture along with the desire, and ideas, to improve it. But trust and support of the management is essential to bringing out and taking the ideas forward.

Creating an environment conducive to innovation is the first step to bringing about innovation-driven outcomes. These were just some of the insights on healthcare management gleaned from the Hospital Leadership Summit hosted by Abbott. In over 150 countries, Abbott, which is among the top 100 global innovator companies, is working with hospitals and healthcare professionals to improve the quality of health services.

To read more content on best practices for hospital leaders, visit Abbott’s Bringing Health to Life portal here.

This article was produced on behalf of Abbott by the marketing team and not by the editorial staff.