P94 Shaping hepatitis D treatment pathways: leveraging the pharmacy team roles

<h3>Introduction</h3> In June 2023, NHS England commissioned the use of bulevirtide as a licensed treatment option for chronic hepatitis D, the most severe form of viral hepatitis which can cause rapid progression to end stage liver disease and hepatocellular carcinoma. As per commissioning requirements, access is limited via specialist hospitals and under strict clinical criteria. As one of the chosen hub sites across England, our trust took the approach of establishing a new referral pathway and new pharmacy led clinic to increase access to this medication for patients in our region. <h3>Methods</h3> A prescribing pathway was developed by the liver pharmacy team in conjunction with the lead clinician. This included the setting up of homecare delivery for bulevirtide, prescribing criteria based on the NICE technology appraisal guidance, referral pathway, prescribing responsibilities, monitoring schedule and parameters. A specific referral proforma was also created and it was decided that the patients should be discussed at our existing viral hepatitis multidisciplinary meeting (MDM) for approval and for educational purposes. A pharmacy led clinic was established to create further capacity to commence patients on this treatment which required longer clinic appointments due to training requirements of reconstituting the vials and subcutaneous injection daily by the patients and collection of additional blood tests for research purposes. Figure 1 shows the simple referral pathway established. A telephone and email helpline was made available to patients and referring clinicians in the event of any adverse effects or if further advice was required. A training event was established to include all potential referring hospitals to inform them of the new pathway and to provide an update on current guidelines and therapies. <h3>Results</h3> In a 9 month period, 14 patients were referred to the MDM with 5/14 (36%) of patients being referred from referral centres and new patients to our trust. In addition to this, 3 patients were also referred from Belfast for advice. 12/14 (86%) of patients were commenced on bulevirtide, 1 patient was referred to the clinical trial team and one patient commenced bulevirtide at a local hospital. Of the 12 patients commenced on bulevirtide treatment, all have continued to date with no problems with reconstituting or self-administering a daily injection, nor any major side effects. <h3>Conclusions</h3> A robust treatment pathway and the use of pharmacy teams to increase clinic capacity can improve access to novel, high-cost treatments for hepatitis D.