Monitoring hepatitis C treatment
uptake in Australia Issue #13 July 20231
Executive summary A total of 105,024 individuals have initiated direct acting antiviral (DAA) treatment for chronic hepatitis C virus (HCV) infection in Australia, including 100,684 individuals through Pharmaceutical Benefits Scheme (PBS) during 2016 to 2022, and an estimated 4,340 individuals through early DAA access avenues in 2014-15. In 2022, 5,205 individuals initiated treatment (first course), increasing from 1,141 in the first quarter to 1,432 in the last quarter of 2022. The recent increase in treatment uptake could be explained by enhanced HCV testing programs implemented in the community and prisons in several jurisdictions. Among individuals initiating DAA treatment during 2016 to 2022 (n=100,684), 68% were men, and median age was 47 years (quartiles 1-3: 38-57). Since August 2018 when both pan-genotypic regimens were available (i.e., sofosbuvir/velpatasvir and glecaprevir/pibrentasvir), 53% of individuals have been initiated on sofosbuvir/velpatasvir, 41% on glecaprevir/pibrentasvir, and 6% on other regimens. Most individuals initiating DAA treatment, received their prescriptions from general practitioners (GPs; 46%), followed by gastroenterologists (35%). Overall, 52% of individuals were initiated on treatment by specialists, and 48% by non-specialists (i.e., GPs and nurse practitioners). A total of 2,048 individuals
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were initiated on treatment by nurse practitioners, increasing from 92 in 2017 to 535 in 2022. Among individuals initiating DAA treatment during 2016 to 2022, 8.6% discontinued treatment, including 4.0% early discontinuation (i.e., dispensed 28 days of treatment) and 4.6% late discontinuation (i.e., dispensed at least 56 days of treatment, but not all recommended duration). The proportion of early discontinuation increased from less than 3% in 2016 to 8-9% in 2021, followed by a relatively stable trend during 2022. Among individuals who discontinued treatment, 26% received re-treatment. Among individuals initiating DAA treatment during 2016 to 2022, 8.5% received at least one course of re-treatment. Among re-treatment initiations, an estimated 57% were for HCV re-infection and 43% for treatment failure. The number of re-treatment initiations for treatment failure increased during the second quarter of 2019, corresponding to sofosbuvir/ velpatasvir/voxilaprevir availability through PBS (April 2019), and has decreased since. The number of retreatment initiations for HCV re-infection increased until mid-2020, stabilised during 2020-21, and increased again in 2022. This latest increase could be the result of enhanced HCV testing programs implemented in several jurisdictions through which many individuals with HCV re-infection were diagnosed and linked to clinical care.
Hajarizadeh B, Carson JM, Dore GJ. Monitoring hepatitis C treatment uptake in Australia (Issue 13). The Kirby Institute, UNSW, Sydney NSW, Australia, July 2023, DOI: 10.26190/81wp-fr56 (available online at: https://www.kirby.unsw.edu.au/research/reports/monitoring-hepatitis-c-treatmentuptake-australia-issue-13-july-2023 ). For more information, contact Dr Behzad Hajarizadeh (bhajarizadeh@kirby.unsw.edu.au).
Issue #13
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