The cost of treating hepatitis C with PBS-listed direct acting antivirals (DAAs) has reached almost $6 billion, new government figures show.
When DAAs were listed on the PBS in March 2016, the then health minister Sussan Ley said the government had budgeted $1.3 billion to subsidise the drugs that would otherwise cost up to $50,000 per course of treatment.
However in a response to a Question on Notice in Senate Estimates, the Department of Health has revealed that the gross Commonwealth expenditure (excluding rebates) from 1 March 2016 to 30 September 2019 has been over $5.5 billion.
These costs cover the brands Maviret (glecaprevir + pibrentasvir), Epclusa (sofosbuvir + velpatasvir), Zepatier (elbasvir + grazoprevir) Daklinza (daclatazvir), Harvoni (ledipasvir + sofosbuvir), Sovaldi (sofosbuvir), Vosevi (sofosbuvir + velpatasvir + voxilaprevir), as well as the delisted brands Viekira Pak (paritaprevir + ritonavir + ombitasvir + dasabuvir) and Viekira Pak-RBV (with ribavirin).
Other figures released by the department show that the uptake of DAAs is slowing and has fallen more than half since they were first listed on the PBS. The number of new initiations of DAA therapy peaked at 2158 per month in August 2017, but had declined to 958 by August 2019.
In a recent statement, Hepatitis Australia said that around 70,000 people of the estimated 230,000 people living with chronic hep C across Australia have accessed the new treatments.
However it said there was a need for additional harm reduction measures such as needle and syringe programs in prisons (where 26% of inmates have HCV) if Australia is to meet its goal of eradicating hepatitis C by 2025.
This is backed up by new figures showing that people in prison with HCV are being reinfected up to four times after receiving DAA treatment, due to the sharing of HCV contaminated needles.
A report from the NSW Justice Health and Forensic Mental Health Network shows that 3192 people in NSW prison have been treated with DAAs by the Network up to June 30 2019, of whom 247 patients required DAA treatment for HCV a second time; thirteen patients for a third time; and, one patient for a fourth time.
Of this group, 117 patients were in custody continuously between each treatment episode and 62 were serologically confirmed as definite reinfections.
“This result indicates that over 50% of patients, who remained in custody, needed to be retreated due to a confirmed reinfection,” they wrote in a letter to the International Journal of Drug Policy.
Given the high rates of reinfection they recommended that evidence based strategies including prison needle exchange programs, opioid agonist treatment and harm reduction education programs be introduced and/r increased in NSW and other jurisdictions to support upscaling HCV treatment, they said.
But prison needle exchange programs have been ruled out by the NSW government in the face of strong opposition by prison staff, who say that needles could be used as weapons by inmates.
The NSW Corrective Services department revealed that the cost of antiviral medications for prisons in the last year (2018-19) was $57.6 million.