Monitoring hepatitis C treatment uptake in Australia
Issue #15 July 20251
Executive summary
A total of 111,184 individuals initiated at least one course of direct-acting antiviral (DAA) therapy for chronic hepatitis C virus (HCV) infection in Australia through the Pharmaceutical Benefits Scheme between 2016 and 2024. During this period, 13,637 (12%) individuals received a second course of treatment, and 4,412 (4%) received more than two courses. The annual number of treatment initiations declined from 2016 to 2022, followed by increases in 2023 and 2024. In 2024, 8,264 individuals received treatment, comprising 5,238 (63%) initial treatments and 3,026 (37%) re-treatments.
Between 2016 and 2024, a total of 18,049 DAA re-treatment courses were dispensed, of which an estimated 58% were for HCV re-infection and 42% for treatment failure. The annual number of re-treatments for re-infection increased over time, while re-treatments for treatment failure declined after 2019 and then plateaued from 2021 onwards. In 2024, of the 3,026 re-treatments, 74% were for re-infection and 26% for treatment failure.
Among those receiving their first DAA treatment between 2016 and 2024, 47% were prescribed treatment by general practitioners (GPs), followed by 34% by gastroenterologists. The contribution of non-specialists (i.e., GPs and nurse practitioners [NPs]) to DAA prescribing increased over time. In 2024, 54% of individuals were initiated on treatment by GPs, 18% by gastroenterologists, 10% by NPs, and 18% by other prescribers.
1. The Kirby Institute. Monitoring hepatitis C treatment uptake in Australia (Issue 15). The Kirby Institute, UNSW, Sydney NSW, Australia, July 2025 (available online at: https://www.kirby.unsw.edu.au/research/reports/monitoring-hepatitis-c-treatment-uptake-australia-issue-15-july-2025 For more information, contact Dr Behzad Hajarizadeh (bhajarizadeh@kirby.unsw.edu.au).
Box 1. Access to direct-acting antiviral therapies in Australia
Government subsidised direct-acting antiviral (DAA) regimens for hepatitis C virus (HCV), were listed on the Pharmaceutical Benefits Scheme (PBS) from March 2016. There were no restrictions on authorised prescribers or on individuals with HCV accessing treatment.
Genotype‑specific regimens were available as follow:
• March 2016: sofosbuvir/ledipasvir (Harvoni®), sofosbuvir+daclatasvir (Sovaldi®+Daklinza®), sofosbuvir+ribavirin (Sovaldi®+Ibavyr®)
• May 2016: paritaprevir/ritonavir/ ombitasvir+dasabuvir (Viekira PAK®)
• January 2017: elbasvir/grazoprevir (Zepatier®)
Pangenotypic regimens were available as follow:
• August 2017: sofosbuvir/velpatasvir (Epclusa®)
• August 2018: glecaprevir/pibrentasvir (Maviret®)
• April 2019: sofosbuvir/velpatasvir/voxilaprevir (Vosevi®)
From 2022, genotype‑specific DAAs had been delisted from the PBS, and genotype testing was no longer required to gain PBS approval for prescribing. Pangenotypic DAAs continue to be available.
Issue #15 of the newsletter provides data on HCV treatment and re-treatment uptake in Australia between March 2016 and December 2024. Treatment uptake is also reported by states and territories and by prescriber type. For re-treatments, estimated numbers and trends of re-treatment for HCV re-infection and treatment failure are reported. PBS data on DAA prescriptions dispensed in Australia between March 2016 and December 2024 were used for data analyses. Detailed methodology is provided on page 7.
DAA treatment uptake
A total of 111,184 individuals initiated DAA treatment (first course) through the PBS between March 2016 and December 2024 in Australia. During this period, 13,637 (12%) individuals received a second course of treatment, and 4,412 (4%) individuals received more than two courses.
The annual number of treatment initiations showed a decreasing trend from 2016 to 2022, with 32,879 treatment initiations in 2016 declining to 7,462 in 2022. However, treatment uptake increased thereafter, with 8,508 and 8,264 treatments initiated in 2023 and 2024, respectively (Figure 1). In 2024, of the 8,264 treatments initiated, 5,238 (63%) were initial treatments and 3,026 (37%) were re-treatments.
At the jurisdictional level, the total number of DAA treatment initiations between March 2016 and December 2025 included 44,253 (34%) in New South Wales, 30,390 (24%) in Queensland, 29,460 (23%) in Victoria, 12,326 (10%) in Western Australia, 7,027 (5%) in South Australia, 2,908 (2%) in Tasmania, 1,806 (1%) in Australian Capital Territory, and 1,063 (1%) in Northern Territory.
The quarterly number of DAA treatment initiations in each state and territory between 2020 and 2024 is illustrated in Figure 2. Similar trends to those observed in national treatment uptake, with treatment initiations increasing again from early- to mid-2022,
were seen in most jurisdictions. This increase was particularly marked in New South Wales and Queensland. Enhanced HCV testing programs in the community and prisons in several jurisdictions, started in 2022, could be one of the factors contributing to the recent increases observed in DAA treatment initiations. These screening programs, largely targeting high-risk populations, increase the capacity for detection of both initial HCV infections and HCV re-infections. Another potential explanation is the diversion of healthcare resources to the COVID-19 response during the pandemic, with HCV treatment services resuming as pandemic-related demands eased.
DAA re‑treatment for re‑infection or treatment failure
Among people who receive HCV treatment, some may need further courses of treatment due to treatment failure or post-treatment HCV re-infection. Between 2016 and 2024, a total of 18,049 DAA re-treatment courses were dispensed, of which an estimated 58% (n=10,530) were for HCV re-infection and 42% (n=7,519) for treatment failure (Figure 3). In 2024,
of the 3,026 re-treatments, 74% (n=2,229) were for re-infection and 26% (n=797) for treatment failure.
Among DAA re-treatment initiations, the proportion due to HCV re-infection was higher in men (62%) compared to women (38%; Figure 3B).
Re-treatment for treatment failure
The longitudinal trend in re-treatment uptake is illustrated in Figure 4. Following 2019, a decreasing trend in the number of re-treatment initiations for treatment failure was observed, which has stabilised since 2022. Notably, sofosbuvir/velpatasvir/ voxilaprevir was listed on the PBS in April 2019. In contrast, re-treatment initiations for re-infection showed an overall increasing trend over time. As shown in Figure 4, the semiannual number of
re-treatments for re-infection increased until 2020, followed by a temporary decline during 2021–2022, and then a subsequent increase after 2022. The recent rise in re-treatment for re-infection aligns with the trend observed for initial treatment uptake, although the increase appears more pronounced for re-treatment.
Re-treatment for treatment failure
Re-treatment for re-infection
Total re-treatment
Distribution of health care providers prescribing DAA treatment
Among individuals receiving their first DAA treatment between 2016 and 2024, 47% were prescribed treatment by general practitioners (GPs), followed by 34% by gastroenterologists, 16% by other specialists, and 3% by nurse practitioners (NPs). The contribution of non-specialists (i.e., GPs and NPs) to DAA prescribing increased over time. The proportion of individuals initiated on treatment by GPs increased
from 2016 to 2018 and then remained relatively stable. Since 2017, when NPs were authorised to prescribe DAAs, there has been a steady increase in the proportion of individuals initiated on treatment by NPs (Figure 5). In 2024, 54% of individuals were initiated on treatment by GPs, 18% by gastroenterologists, 10% by NPs, and 18% by other prescribers.
Methodology
The PBS data on all DAA prescriptions dispensed between March 2016 and December 2024 in Australia were used in the analyses. The data used for estimating the initial treatment uptake included the first DAA treatment course prescribed for each individual. The data of the second or further courses of treatment were used for estimating re-treatment uptake. Prescriber speciality was based on the prescriber derived major speciality codes recorded by PBS. In this coding system, medical trainees (i.e., registrars) are considered as specialists. Jurisdictions are based on the individual’s residence at the time of treatment prescription.
Retreatment was defined as commencement of a different DAA prescription any time after estimated end of treatment date (unless initial regimen was discontinued). Reason for retreatment (i.e., treatment failure or reinfection) is not captured in PBS data. A supervised machine learning model (random forest architecture; sensitivity 96%, specificity 97%) was developed using real-world standard-of-care data from the REACH-C study (10,843 treated; 350 re-treated with reason available).2,3 The model was applied to the PBS data to classify retreatments for reinfection or treatment failure. Details of the machine learning algorithm, model training procedure, and model performance metrics were described previously.4
Drug Policy 2021; 96: 103422.
3. Carson JM, Hajarizadeh B, Hanson J, O’Beirne J, Iser D, Read P, Balcomb A, Davies J, Doyle JS, Yee J, Martinello M,
P, Matthews GV, Dore GJ. Retreatment for hepatitis C virus direct-acting antiviral therapy virological failure in primary and tertiary settings: The REACH-C cohort. Journal of Viral Hepatitis 2022; 29(8): 661–76.
4. Carson JM, Barbieri S, Matthews GV, Dore GJ, Hajarizadeh B. National trends in retreatment of HCV due to reinfection or treatment failure in Australia. Journal of Hepatology 2023; 78(2): 260-70.