Japan’s hepatitis programme frees people from disease and financial hardship

July 2018

At age 67, Sachiko Miyamoto from Kanazawa, Japan was surprised to learn she had hepatitis C. She had gone to hospital for an unrelated injury and did not have any symptoms. The news, delivered by her son, was upsetting.

While Sachiko knew the virus is transmitted from unsafe injections and blood transfusions, she never suspected she was infected.

Following the diagnosis, her doctor recommended a 12-month course of interferon injections and ribavirin, but she stopped after nine. The side-effects were unbearable. She lost her appetite and hair – and her sense of taste. Moreover, the costs of therapy were tremendous – full treatment was ¥2 million (US$ 18 000) a year. Even when two-thirds of the expenses were covered by the national health insurance, Sachiko had to pay about ¥50 000 (US$ 450) a month. She decided to discontinue the treatment, and continued working at her family’s restaurant and souvenir shop.

Sachiko is one among the estimated 739 000 people living with chronic hepatitis C in Japan, where hepatitis B and C are the main causes of cirrhosis and liver cancer in the country. Treatment has been available for more than a decade, but the standard therapy using interferon injections was expensive and difficult to complete because of the side effects, as Sachiko had experienced. Fortunately, there are now direct-acting antiviral (DAA) oral medicines that cure 9 out of 10 persons of hepatitis C infection within three to six months, and with few to no side effects.

From testing to treatment

With DAA medicines, cure is possible, provided that people living with hepatitis C are tested, know their own status and provided treatment. “Once diagnosed, it is critical to connect people living with hepatitis to doctors who can provide treatment, continuous care and monitor the disease,” says Dr Tetsuro Shimakami, a physician at Kanazawa University Hospital. “Left untreated, viral hepatitis is likely to progress to cirrhosis and subsequently liver cancer, often without noticeable symptoms.”

The Government has been providing free hepatitis testing since 2002 for all citizens between 40 and 70 years of age as part of routine health check-up. Five years later, patient management was strengthened by the establishment of the community hepatitis care network which links primary care physicians with specialised regional centres to jointly co-manage liver disease.

Because hepatitis treatment was costly, the government also started a special subsidy programme in 2008 to reduce the burden of out-of-pocket costs by patients. These subsidies are borne by both national and local governments. Today, people living with hepatitis pay ¥10 000 or 20 000 (approximately US$ 100 or 200) per month based on their income, including the costs of drugs, medical appointments and laboratory tests.

Subsidised costs for hepatitis care means that people like Sachiko can access the best possible treatment using DAA medicines to cure hepatitis C. Ten years after Sachiko’s failed treatment attempt with interferon, she again started treatment with the new DAA medicines. She had no problems with any side effects, and with support from the national health insurance system, she paid ¥10 000 (US$ 90) per month of treatment. After six months, she was cured.

Today, at age 81, Sachiko goes to the doctor every six months to monitor her liver function and screen for liver cancer. She remains well and enjoys spending time with her five grandchildren and travelling.