Funding moves take on hepatitis B
New moves to tackle the leading cause of liver cancer have been announced by drug-funding agency PHARMAC.
From 1 May 2006 access will be widened to lamivudine (Zeffix), and a new type of hepatitis therapy, adefovir (Hepsera)
will be funded.
Hepatitis B, a virus that causes infection of the liver, causes up to 90 percent of liver cancer. Hepatitis B is the
most prevalent form of hepatitis, estimated to affect about 80,000 New Zealanders, most of whom will never know they
carry the virus until they present with symptoms from advanced liver disease.
New Zealand has high rates of Hepatitis B compared to other countries, with higher rates of infection among Maori,
Pacific Island ,Chinese and South East Asian communities.
PHARMAC Chief Executive Wayne McNee says the changes to lamivudine (Zeffix) access criteria and the listing of adefovir
(Hepsera) will mean further treatment options for about 1000 patients over three years. These decisions are expected to
result in additional expenditure of $6.3 million over five years.
“This is the most prevalent form of hepatitis and left untreated can lead to complications such as liver failure, which
requires liver transplantation, or liver cancer. In some cases, it can be fatal.” Wayne McNee says.
“Antiviral therapies such as lamivudine and adefovir are important in preventing the disease advancing to the stage
where patients develop other complications. This is a decision based on clinical advice that there are further benefits
in extending access to lamivudine, and listing a new treatment option for Hepatitis B, adefovir.”
“Adefovir is a relatively new treatment for hepatitis, having only been approved by Medsafe in August 2005. We are
pleased to have been able to move quickly to subsidise this important medicine for patients.”
Associate Professor Ed Gane, Hepatologist in Charge of the NZ Liver Unit at Auckland City Hospital, welcomes the
changes.
“Chronic hepatitis B affects more than 80,000 New Zealanders and is responsible for most cases of liver failure and
liver cancer in this country,” Prof Gane says.
“The decision by PHARMAC to fund lamivudine in 2000 represented the first advance in the management of this condition.
Since then, more than 1500 New Zealanders have been treated with lamivudine, many of whom already had very advanced
liver disease.
“Over this period, the proportion of liver transplants performed for chronic hepatitis B has fallen from more than 50%
to less than 5%. Unfortunately, some of these patients have subsequently developed lamivudine resistance, resulting in
hepatitis flares, liver failure and death. Adefovir will now provide an effective means to rescue these patients and
further reduce the need for liver transplantation.
“Therefore, this decision by PHARMAC to expand criteria for lamivudine treatment and to provide adefovir rescue therapy
for lamivudine resistance will ensure that New Zealanders with chronic hepatitis B infection will have access to the
best antiviral therapies currently available.”
Under the changes, subsidised lamivudine treatment can continue beyond three years and extend to other patient groups,
such as breast feeding and pregnant women and patients with hepatocellular carcinoma.
Lamivudine will also be subsidised when used in combination with adefovir, either in patients with cirrhosis or
following failure of adefovir treatment on its own. Adefovir is subsidised for patients who have become resistant to
lamivudine.
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