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 

How sustainable farming practices can secure India's food for the future

India is home to 15% of the world’s undernourished population.

Food security is a pressing problem in India and in the world. According to the Food and Agriculture Organization of the UN (FAO), it is estimated that over 190 million people go hungry every day in the country.

Evidence for India’s food challenge can be found in the fact that the yield per hectare of rice, one of India’s principal crops, is 2177 kgs per hectare, lagging behind countries such as China and Brazil that have yield rates of 4263 kgs/hectare and 3265 kgs/hectare respectively. The cereal yield per hectare in the country is also 2,981 kgs per hectare, lagging far behind countries such as China, Japan and the US.

The slow growth of agricultural production in India can be attributed to an inefficient rural transport system, lack of awareness about the treatment of crops, limited access to modern farming technology and the shrinking agricultural land due to urbanization. Add to that, an irregular monsoon and the fact that 63% of agricultural land is dependent on rainfall further increase the difficulties we face.

Despite these odds, there is huge potential for India to increase its agricultural productivity to meet the food requirements of its growing population.

The good news is that experience in India and other countries shows that the adoption of sustainable farming practices can increase both productivity and reduce ecological harm.

Sustainable agriculture techniques enable higher resource efficiency – they help produce greater agricultural output while using lesser land, water and energy, ensuring profitability for the farmer. These essentially include methods that, among other things, protect and enhance the crops and the soil, improve water absorption and use efficient seed treatments. While Indian farmers have traditionally followed these principles, new technology now makes them more effective.

For example, for soil enhancement, certified biodegradable mulch films are now available. A mulch film is a layer of protective material applied to soil to conserve moisture and fertility. Most mulch films used in agriculture today are made of polyethylene (PE), which has the unwanted overhead of disposal. It is a labour intensive and time-consuming process to remove the PE mulch film after usage. If not done, it affects soil quality and hence, crop yield. An independently certified biodegradable mulch film, on the other hand, is directly absorbed by the microorganisms in the soil. It conserves the soil properties, eliminates soil contamination, and saves the labor cost that comes with PE mulch films.

The other perpetual challenge for India’s farms is the availability of water. Many food crops like rice and sugarcane have a high-water requirement. In a country like India, where majority of the agricultural land is rain-fed, low rainfall years can wreak havoc for crops and cause a slew of other problems - a surge in crop prices and a reduction in access to essential food items. Again, Indian farmers have long experience in water conservation that can now be enhanced through technology.

Seeds can now be treated with enhancements that help them improve their root systems. This leads to more efficient water absorption.

In addition to soil and water management, the third big factor, better seed treatment, can also significantly improve crop health and boost productivity. These solutions include application of fungicides and insecticides that protect the seed from unwanted fungi and parasites that can damage crops or hinder growth, and increase productivity.

While sustainable agriculture through soil, water and seed management can increase crop yields, an efficient warehousing and distribution system is also necessary to ensure that the output reaches the consumers. According to a study by CIPHET, Indian government’s harvest-research body, up to 67 million tons of food get wasted every year — a quantity equivalent to that consumed by the entire state of Bihar in a year. Perishables, such as fruits and vegetables, end up rotting in store houses or during transportation due to pests, erratic weather and the lack of modern storage facilities. In fact, simply bringing down food wastage and increasing the efficiency in distribution alone can significantly help improve food security. Innovations such as special tarpaulins, that keep perishables cool during transit, and more efficient insulation solutions can reduce rotting and reduce energy usage in cold storage.

Thus, all three aspects — production, storage, and distribution — need to be optimized if India is to feed its ever-growing population.

One company working to drive increased sustainability down the entire agriculture value chain is BASF. For example, the company offers cutting edge seed treatments that protect crops from disease and provide plant health benefits such as enhanced vitality and better tolerance for stress and cold. In addition, BASF has developed a biodegradable mulch film from its ecovio® bioplastic that is certified compostable – meaning farmers can reap the benefits of better soil without risk of contamination or increased labor costs. These and more of the company’s innovations are helping farmers in India achieve higher and more sustainable yields.

Of course, products are only one part of the solution. The company also recognizes the importance of training farmers in sustainable farming practices and in the safe use of its products. To this end, BASF engaged in a widespread farmer outreach program called Samruddhi from 2007 to 2014. Their ‘Suraksha Hamesha’ (safety always) program reached over 23,000 farmers and 4,000 spray men across India in 2016 alone. In addition to training, the company also offers a ‘Sanrakshan® Kit’ to farmers that includes personal protection tools and equipment. All these efforts serve to spread awareness about the sustainable and responsible use of crop protection products – ensuring that farmers stay safe while producing good quality food.

Interested in learning more about BASF’s work in sustainable agriculture? See here.

This article was produced by the Scroll marketing team on behalf of BASF and not by the Scroll editorial team.