GPs across Western Australia will receive a new chronic hepatitis B
and C primary care pathway later this month. WA Health has developed
the pathway to assist GPs and primary health care providers assess and
manage patients with hepatitis B or hepatitis C in the community.
Across Australia, only a small proportion of those living with
chronic hepatitis B or C are accessing treatment. Treatment with
antiviral medication can significantly reduce the risk of complications
such as cirrhosis and liver failure.
The clinical pathway has been developed in close collaboration
with key stakeholders, and contains up-to-date evidence-based
recommendations as well as links to a range of patient and health
It provides a quick guide for GPs and summarises:
- what patients can do to optimise their own health
- how to manage their long-term care
- which patients to refer
- how to refer
- where to go for more information.
Thanks to all the clinicians, GPs, Communicable Disease Control
Directorate staff and non-government organisations that supported the
development of this resource.
For more information, visit the Public Health website (external site) and download the primary care pathway (PDF 810KB).
The high price on one hand and the urgency to provide treatment for
chronic Hepatitis C Virus (HCV) infection on the other has become a
dilemma for healthcare professionals, hospital representatives,
insurers, and patient advocates including Medicaid as to how to go about
administering these medicines. This was the agenda at a recent meeting
for the California Technology Assessment Forum (CATF), a group
affiliated with health insurers conducting meetings in the wake of
advances made in treatment options. It was estimated that any line of
treatment carried on with these two drugs could cost as much as $66,000
to $84,000 in one course — an amount that would make the entire health
insurance system go bankrupt.
Finding a feasible solution to this issue was no less a challenge for
the 15 member panel who convened the meeting. It was agreed upon
however, that with the drug makers having defended their pricing, owing
to the efficacy and potential against chronic HCV, there is currently no
scope of a possible price reduction. According to Rena K. Fox, a
professor of medicine at the University of California, San Francisco,
“What I really wish for is that we could push back on the price, rather
than make patients wait. But since we don’t have the ability to change
the price, we have to decide which patients are the most urgent.” Hence,
in a country where almost 3 to 5 million people are diagnosed by HCV
every year, it became necessary to prioritize the needs of each patient
by assessing the severity of infection.
Morbidity and mortality from co-morbid hepatitis C (HCV) infection in HIV co-infected
patients are increasing; hence, the management of hepatitis co-infection in HIV is
now one of the most important clinical challenges. Therefore, the development of direct
acting antivirals (DAAs) for treatment of HCV has been eagerly awaited to hopefully
improve HCV treatment outcome in co-infected individuals. Indeed, the availability
of the first HCV protease inhibitors (PI) boceprevir and telaprevir for HCV genotype
1 patients has changed the gold standard of treating hepatitis C allowing for substantially
improved HCV cure rates under triple HCV-PI/pegylated interferon/ribavirin therapy.
Moreover, numerous other new DAAs are currently being studied in co-infected patient
populations, also exploring shorter treatment durations and interferon-free treatment
approaches promising much easier and better tolerated treatment regimens in the near
future. Nevertheless, numerous challenges remain, including choice of patients to
treat, potential for drug-drug interactions and overlapping toxicities between HIV
and HCV therapy. The dramatically improved rates of HCV cure under new triple therapy,
however, warrant evaluation of these new treatment options for all co-infected patients.
Read complete article here….