How Rohtak is saving Hepatitis C patients at just Rs 18,600

The state of Haryana is leading a movement in medical science that few are aware of.

The state is providing treatment of Hepatitis C (Hep C) at an unprecedented low cost. The 12-week Hep C treatment at All India Institute of Medical Science, Delhi is Rs 60,000, excluding diagnostic tests — which can cost anywhere between Rs 5,000 to Rs 15,000 on multiple occasions. In Haryana the same treatment is priced at Rs 18,600, inclusive of tests.

How is this possible? The answer is a conscientious doctor, a supportive state government and (surprisingly) free market competition.

Ground Zero: PGIMS Rohtak

A clean, sterile ambience pervaded Ward number 33 of the Post Graduate Institute of Medical Sciences (PGIMS), Rohtak on the late afternoon of October 4. Posters with supportive faces promise solidarity with patients in fighting Kala Peeliya (Hep C).

This wasn’t always the scene. Till 2010, PGIMS Rohtak did not treat Hep C patients at all. Patients were referred to mostly Delhi. Now, six years later, the institute gets approximately 20-25 Hep C patients every day, according to Dr Praveen Malhotra, Head of Hepatology at the institute. He was also the one to start the department in PGIMS Rohtak in 2010.

“Hep C is a lower middle and lower class disease. As the price of treatment dropped, the number of patients increased,” Malhotra told Newslaundry. Of all the approaches Malhotra adopted in fighting the disease, his efforts in reducing the treatment cost have been one of the most fruitful.

Initially, the medicine of choice for the Hep C was Pegylated interferon. Each injection of interferon cost Rs 16,500. The 24-week treatment, with an injection everyday, costs patients around Rs 2 lakh. Apart from the cost, interferon had side effects ranging from high fever, weakness, sexual impotence to sugar problems, hair-fall and thyroid issues.

“Things changed with the generic release of the miracle drug Sofosbuvir in India. It was the game changer,” Malhotra explained.

The Haryana state government also played its part. When the Hep C rate, in a small sample of 7,500 people in Haryana (there are 10-12 million Hep C patients in India), was found to be 10 per cent, the government launched the “Jeevan Rekha” scheme.

“This scheme deals with the treatment of Hep C. Under Jeevan Rekha we provide free drugs to Schedule Caste and below poverty line patients and drugs for general category is subsidized to the price at which we buy them from companies,” Dr Aparajita, Deputy Director of Health Services of Haryana told Newslaundry.PGIMS Rohtak was made the nodal centre for starting the scheme.

Many have benefited from the scheme. “Jindal Hospital wanted Rs 6 lakh for my wife’s treatment,” Rajesh Kumar said. A tailor by profession, he could not afford the private treatment. His wife was treated for free in PGIMS Rohtak under the Jeevan Rekha scheme.

But the journey of Sofosbuvir was not without its bumps.

The cost of saving a life

After years of research, in 2013, an oral drug for Hepatitis C with 99.5 per cent success rate was created —Sofosbuvir.

A US pharmaceutical company Gilead Sciences, had filed a patent application for Sofosbuvir, also known as “sofo,” which it sold under the brand name Sovaldi.In March 2015, the company decided to enter into a generic licensing agreement with an Indian pharmaceutical company, Hetero.But Gilead had come under sharp criticism for the price it was charging: Sovaldi was launched in the United States at $1,000 per pill, or $84,000 for the course of the 12-week treatement.

Step two in democratising the elite drug came with the release of Sof ledi and Sof daclatasvir on December 20, 2015. The two drugs were combinations of sofosbuvir (400 mg) with ledipasvir(90 mg) and daclatasvir(60 mg). They were released in India at Rs 25,000. In Gurgaon its price was Rs 21,000. But this was nowhere near the price at which they were launched in PGIMS Rohtak — Rs 14,000.

Now, the price of the same tablets have come down to just Rs 6,200. Malhotra explained,”We made it clear that the company which will give the drug for the cheapest amount will get the tender.”

“Every company has its policies for pricing drugs in a territory, which are confidential,” a medical representative of Hetero Drugs told Newslaundry on condition of anonymity. Hetero Drugs manufactures Sofosbuvir in India. “In Haryana, the prices are low mostly because of government policies and efforts of Dr Malhotra of PGIMS Rohtak,” he added.

In fact, Haryana worked on the well-known principle of free market competition, in one of the very rare instances where it has helped the consumers.

The government buys drugs from pharmaceutical companies at bulk rates for which tenders are issued. As economy of scale kicks in, pharma companies sell the drugs on cheaper rates to the government. Malhotra’s strategy to pit one company against other in terms of cost made drugs cheaper still. From Rs 14,000 to Rs 12,000, then to Rs 8,000 and now finally the prices are less than half and stand at Rs 6,200.

But the process didn’t end with this. Under the Jeevan Rekha scheme even the diagnostic tests are free for patients. The expense is borne by the pharmaceutical company. In fact, according to Dr Aparajita the prices are going to go down further.

In any case, the treatment is the cheapest in India and possibly the world.

How to save a life

“Nowhere in the country is the public healthcare system treating Hep C,” Doctors Without Borders/Médecins Sans Frontières (MSF) South Asia Access Campaign Head, Leena Menghaney told Newslaundry, adding, “In this sense, what PGIMS Rohtak has done in India, is absolutely revolutionary.”

According to her, what Haryana has done is to adopt a people’s rights approach to Hep C.

“The critical illness fund in Manipur was used to reimburse cost of treatment to a few people. Similarly in other places, people appealed to health departments and some patients were able to get help,” Menghaney said, emphasising that PGIMS Rohtak’s success lies in making the treatment available at affordable prices to people.

Apart from reducing the cost, a lot of effort has gone in to create awareness about the disease.

“People did not report the disease because it is very similar to HIV,” Malhotra explained. “We have countered that by creating teams of cheerleaders like in cricket matches.”Patients who have undergone successful treatment spread awareness about the disease.

In fact, Rajesh Kumar is one of the cheerleaders. “Since my wife’s successful treatment I have been spreading awareness about the disease. I take people to PGIMS for treatment,” he said. With Kumar’s help, more than 200 patients from his area have been treated. And that too, for free.

Haryana’s journey from a region that did not treat Hep C, to being the model in the fight against the disease is remarkable. And the effort is ongoing.

“Within two months, we will expand Jeevan Rekha scheme to include other hospitals also,” Aparajita said.