7 Implementation and audit
7.1 When NICE recommends a treatment 'as an option', the NHS must make sure it is available within 3 months of this guidance being published. This means that, if a patient has chronic hepatitis B and the doctor responsible for their care thinks that adefovir dipivoxil or peginterferon alfa-2a is the right treatment, it should be available for use, in line with NICE's recommendations.
7.2 All clinicians who care for people with chronic hepatitis B should review their current practice and policies to take account of the guidance set out in section 1.
7.3 Local guidelines, protocols or care pathways that refer to the care of people with chronic hepatitis B should incorporate the guidance.
7.4 To measure compliance locally with the guidance, the following criteria could be used. Further details on suggestions for audit are presented in appendix C.
7.4.1 For an adult with chronic hepatitis B (HBeAg-positive or -negative), peginterferon alfa-2a is considered as an option for the initial treatment, within its licensed indications.
7.4.2 For an adult with chronic hepatitis B (HBeAg-positive or -negative) adefovir dipivoxil is considered as an option for treatment, within its licensed indications, if:
treatment with interferon alfa or peginterferon alfa-2a has been unsuccessful, or
a relapse occurs after successful initial treatment, or
treatment with interferon alfa or peginterferon alfa-2a is poorly tolerated or contraindicated.
7.4.3 Adefovir dipivoxil is not normally given before treatment with lamivudine.
7.4.4 Adefovir dipivoxil is normally used either alone or in combination with lamivudine when:
treatment with lamivudine has resulted in viral resistance, or
lamivudine resistance is likely to occur rapidly and development of lamivudine resistance is likely to have an adverse outcome.
7.4.5 Drug treatment with peginterferon alfa-2a and adefovir dipivoxil is initiated by an appropriately qualified healthcare professional with expertise in the management of viral hepatitis.
7.5 Local clinical audits also could include measures related to the existence of clear, long-term management plans for people with chronic hepatitis B; the provision of written information to patients on the transmission and outcomes of the disease; the regularity of ALT level checks; the clinical supervision of the patients' care; and the coordination of data collection for local audits with national audits that may include these patients.