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Reuters Health Information (2006-05-24): UK not matching European response to growing hepatitis C threat

Public Health

UK not matching European response to growing hepatitis C threat

Last Updated: 2006-05-24 9:44:08 -0400 (Reuters Health)

LONDON (Agence de Presse Medicale for Reuters Health) - The UK is failing to match the detection and response levels to hepatitis C seen in much of Europe, meaning the cost of tackling the illness in ten years will balloon to 1.8 billion pounds (2.6 billion euros), a report on Wednesday has warned.

In "The UK vs Europe", published by the UK charity The Hepatitis Trust, Professor of Hepatology, William Rosenberg, says unless immediate action is taken, hepatitis C infection will result in an "unacceptable burden on those infected and all who care for and about them, placing an enormous pressure on the healthcare delivery system and society in general".

UK official estimates identify about 200,000 people with chronic hepatitis C (CHC), but in his report the University of Southampton professor says other models suggest those figures dramatically underestimate the true extent of the problem.

"In fact, between 466,000 and 900,000 people are thought to be chronically infected."

Based on the estimate of 200,000 infected people, government statistics state the UK has detected only 19% of those estimated cases and treated fewer than 5%. The treatment figure drops to 1-2% when based on a suggested prevalence of 500,000 infected.

Rosenberg believes there is a stigma prevalent in the UK that HCV is primarily a drug-users' disease, resulting in bias against managing the problem. "By contrast in Europe, tackling this treatable disease is seen as a moral imperative irrespective of the route of acquisition."

Rosenberg, in the Roche-sponsored report, says the UK government and public health authorities must learn from the experience of its European neighbours and make adequate provision for the future.

If not, a growing number of patients with the complications of end-stage liver disease will place "unprecedented demands on the national health service".

Models suggest the financial cost of the UK failing to tackle the problem effectively will rise from 156 million pounds a year (229 million euros) to 1.8 billion pounds (2.6 billion euros) after 10 years.


In many European countries, the prevalence of HCV infection exceeds 1%. "This has led to the introduction of effective policies to detect and treat patients in order to save lives, improve the quality of life of infected patients and reduce the burden of chronic liver disease."

Rosenberg adds: "Unfortunately, the UK has not responded to the threat of the disease in the same way as its European neighbours have. Management of hepatitis C in the UK is acknowledged to be both unstructured and underfunded."

Rosenberg argues it is clear the UK has lessons to learn from Europe.


Setting targets has been a consistent feature of the French strategy and is perceived as a foundation for its success.

French services have treated 75,000 people over the last 15 years, 12.5 times as many patients as those in the UK and nearly 50,000 of them in the last few years.

In one "free testing" day, France diagnoses more cases of hepatitis C than the UK does in three months and, overall, diagnoses five times more patients a year.

Strong political commitment has been key, with a large, ring-fenced budget announced with the first hepatitis C plan. The Second Viral Hepatitis C and Hepatitis B National Program was launched in 2002.

That aimed by 2005 to screen 100% of infected people, reduce the mortality from chronic viral hepatitis B and C by 30% and reduce the proportion of patients with chronic disease from 10-20% to 7-14%.

Patient Advocacy Groups (PAGs) have been key in promoting awareness of hepatitis C in France, having shifted the balance of the legal relationship between doctors and patients in favour of the patients, the report adds.


The report says changes were implemented in the country by the Network of Competence in Hepatitis (HepNet), formed in 2002 as one of 17 government-funded Networks in Medicine developed since 1997.

A group of hepatologists co-ordinated a successful bid for funding to the Ministry for Education and Technology. Separate, dedicated funding has been allocated for five years to fund HepNet across 26 universities, 1,300 associated members and 55 supra-regional projects.

In Germany, where patients who ask to be referred cannot be refused, the percentage of patients seen by a HCV specialist is 80%, the same percentage as in Spain.


High levels of public awareness mean that 60% of patients are referred directly to specialists in hepatitis.

In the country, there are more than 500 centres offering full specialist care, which are able to prescribe treatment, five times higher than the UK, despite a similar total population.

Specialist centres are grouped in regional networks. One northern network, for example, consists of 35 centres, treating 8-250 patients each.

About 100,000 people have been treated so far nationwide, but Rosenberg says that figure is an estimate only because the lack of nationally collected statistics.

Patient groups in Italy are also becoming increasingly active, particularly via the internet. 25,000 people are estimated to belong to PAGs, which are supported by a government grant.

High levels of public awareness mean that 60% of patients are referred directly to specialists in hepatitis.


In the report, Rosenberg and a panel of UK hepatologists are calling on the government to adopt a range of measures seen across Europe. They include:

-- Adopting a detailed strategy for the management of HCV, with detailed targets for detection and treatment. These include diagnosing 50% of those infected in the next three years and treating 25% of them in the next eight years.

-- Appoint an individual to lead strategy development within the Department of Health.

-- Develop and implement an awareness campaign using multiple media and patient representation to broadcast knowledge of the history of the disease and highlight the fact the disease can be fatal, but that effective treatment is available.

-- Improve diagnostic services for HCV, improving access to testing and the communication of test results to the profession and patients.

-- Building an appropriate infrastructure for diagnosis and treatment. The UK will need about 30 major centres for HCV management with local networks linked to each other, with at least one hepatologist and one new nurse specialist to each centre.

-- Establishing a 'diagnosis to treatment highway' for rapid referral and initiation of treatment, with the aim that patients do not wait more than 18 weeks from diagnosis to treatment.

-- Linking clinical activity to a research programme, targeting epidemiology.

The report says these plans will require considerable long-term investment, "but the cost of inaction is too high to be ignored any longer".

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