Chamber and committees

New medicines for the treatment of hepatitis C have recently come onto the market in 2011-12 with many more in the pipeline in coming years, making this a fluid and rapidly advancing clinical environment.

The Scottish Medicines Consortium (SMC) advises NHS boards across Scotland about the status of all newly licensed medicines. The Scottish Medical Consortium assesses the comparative clinical-effectiveness and cost-effectiveness of new medicines, including those for hepatitis C, and will accept for use those that clearly represent good value for money.

The Scottish Medicines Consortium has recently completed its assessment and published advice for several new medicines for hepatitis C (telaprevir, boceprevir and tenofovir disoproxil) through its website. These can be used by NHS boards and other partners to inform local decision making.

Scottish Women's Aid (SWA)'s views on the proposed changes to Housing Benefit were sought and reflected in the Scottish Government's response to the Department for Work and Pensions. SWA also submitted their own response to the consultation, which can be accessed via their website at:

http://www.scottishwomensaid.org.uk/publications/consultation-responses1.

It is estimated that 90% of Scotland’s hepatitis C infected population has injected drugs. It is a matter for individual clinical discretion and the patient concerned as to whether or not an individual is stable enough to commence treatment, however ongoing injecting drug use is not a contraindication of hepatitis c treatment. Many individuals who are current injecting drug users have been treated for hepatitis C in Scotland.

Data published in the UK Hepatitis C Report in 2011 (available from http://www.hpa.org.uk/Publications/InfectiousDiseases/BloodBorneInfections/1107HepCintheUK2011report/) shows that among people initiated on hepatitis C antiviral therapy in sixteen hepatitis C treatment centres across Scotland, and who had reported a risk factor for infection, the proportion who had reported having ever injected drugs increased from 58% among those initiated in 2000 and 2001 to 75% in 2008 and 2009. The proportion who had reported having ever injected drugs and were aged <35 years (an indicator of those who had recently injected drugs) also increased from 18% among those initiated in 2000 and 2001 to 26% in 2008 and 2009.

The Scottish Government is in regular communication with COSLA about the full range of proposed housing benefit changes contained in the Welfare Reform Bill, and the issue of the impact on foster carers and the provision of foster care has been discussed in that context.

It is not possible to fully assess the impacts of the bill until the parliamentary process is exhausted, however the Scottish Government has made representations to the UK Government on this issue. We welcome the recent UK Government announcement that Discretionary Housing Payment budgets across the UK are to be increased in recognition of the potential impacts of the changes on foster carers and other vulnerable groups, but remain concerned about whether that approach provides a sustainable solution in longer term.

Local Managed Care Networks (MCNs) have been established in all large and medium-sized NHS boards across Scotland. Small NHS boards have established links with larger MCNs in line with their scale and infrastructure.

Many of these Managed Care Networks have also expanded recently to cover blood borne viruses more widely, including HIV and hepatitis B in addition to hepatitis C.

The original treatment targets for hepatitis C were set out in the Hepatitis C Phase 2 Action Plan, which was published in 2008. These targets were aspirational and, although supported by significant investment, they were challenging. In 2009-10 it became apparent that the rate of expansion of services across the NHS boards in Scotland was variable and that nationally the original target for that year would not be met. Although investment was provided to support service expansion, the rate of expansion was naturally being restricted by non-financial factors, such as the ability to recruit staff. Therefore, in discussion with the NHS boards, and based on expert advice from Health Protection Scotland, it was agreed that the national targets would be re-calibrated to take account of experience over the first year. Accordingly, targets were revised to 750 in 2009-10 and 1,000 in 2010-11, and funding was adjusted accordingly.

NHS boards are currently exceeding targets and in 2010-11 a total of 1,049 individuals have commenced treatment.

The Sexual Health and Blood Borne Virus Framework includes a commitment to continue to increase the number of people commencing treatment with targets of 1,100 in 2011-12, 1,150 in 2012-13, 1,200 in 2012-14 and 1,250 in 2014-15.

In 2009, 39,000 people living in Scotland were estimated to be chronically infected with hepatitis C.

In terms of question (a), 16,500 (42%) of those estimated to be chronically infected were estimated to have been diagnosed by the end of 2009. More recent data is currently being collated by Health Protection Scotland (HPS) however, if it is assumed that infection rates have remained relatively stable, then the proportion estimated to have been diagnosed with hepatitis C by the end of 2010 will have increased to 45%. Table 1 shows the number of people reported to be diagnosed hepatitis C antibody positive in Scotland, broken down by NHS board. Approximately 70% of diagnosed positive cases will be chronically infected with hepatitis C.

Table 1: The number of people reported to be diagnosed hepatitis C antibody positive in Scotland by NHS board³, data to 31st December 2010: (a) annual number diagnosed by year of earliest positive specimen, (b) cumulative number ever diagnosed and (c) cumulative number ever diagnosed and not known to be dead.

Notes:

1. Identified through data linkage to GROS register of deaths, data to 31 December 2010.

2. Includes NHS Orkney, NHS Shetland and NHS Western Isles.

3. NHS board’ refers to the persons NHS board of residence, or where this is not known, the NHS board of source of referral.

In terms of question (b), the number of chronically infected people initiated on hepatitis C antiviral therapy in Scotland increased annually from 2007. The number of persons initiated has increased from 468 in the financial year 2007-08, to 591 in 2008-09 (exceeding a target of 500), 904 in 2009-10 (exceeding a target of 750) and a total of 1,049 in 2010-11 (exceeding a target of 1,000).

Table 2 shows the number of people initiated on hepatitis C antiviral therapy in Scotland, broken down by NHS board of residence.

Table 2: The number of people commencing a course of hepatitis C antiviral therapy in Scotland during 2010-11 (April 2010-March 2011), by NHS board of residence.

In terms of question (c), data on the numbers of people waiting for treatment to commence is not held centrally.

The Scottish Government published the Sexual Health and Blood Borne Virus Framework in August 2011. This includes recommendations that early diagnosis of individuals affected by blood-borne viruses, including hepatitis C, are a priority area for activity for NHS boards and partners. This builds on very good activity and service expansion already delivered through the Hepatitis C Action Plan.

There were 2,030 and 2,122 new hepatitis C diagnoses made in Scotland during 2009 and 2010, respectively. This compares to an average of 1,580 new diagnoses made per year during 2005-08. There has been a real increase in testing, and therefore diagnosis, over this period. (Increases in diagnosis do not equate to an increase in transmission of the virus.)

The Scottish Intercollegiate Guidelines Network (SIGN) reviewed available evidence in producing it’s guideline, SIGN 92 Management of Hepatitis: A National Clinical Guideline (2006). The guideline recommends population based testing, acknowledging that where the prevalence of HCV is low, economic modelling indicates that universal testing does not convey cost-effective clinical benefit.

The introduction of screening programmes in Scotland is follows advice from the UK National Screening Committee. The NSC does not currently recommend a national screening programme for hepatitis C.

The Hepatitis C Action Plan came to an end in March 2011. Government policy is now set out in the Sexual health and BBV Framework which was launched in August 2011. The Framework is monitored by a robust governance structure, regular reporting and annual multi-agency visits to each NHS board. A series of data indicators have been established to monitor progress against outcomes, and a National Monitoring and Assurance Group has been established to take forward and quality assure this work. This group is jointly chaired by Health Protection Scotland and NSS Information Services Division.