Publications & Reports

Heterogeneity in hepatitis C treatment prescribing and uptake in Australia: a geospatial analysis of a year of unrestricted treatment access.

Scott N, Hainsworth SW, Sacks-Davis R, Pedrana A, Doyle J, Wade A, Hellard M
Disease Elimination Program, Burnet Institute, Melbourne, VIC 3004, Australia.

Abstract

Background and aim: Direct-acting antiviral (DAA) treatments became available for all people living with hepatitis C virus (HCV) in Australia in March 2016. We assess variations in treatment rates and prescribing patterns across Australia’s 338 Statistical Area 3 (SA3) geographical units. Methods: Geocoded DAA treatment initiation data were analysed for the period 1 March 2016 to 30 June 2017. Regression models tested associations between the population demographics and healthcare service coverage of geographical areas and (a) their treatment rates; and (b) the proportion of prescriptions written by specialists compared to non-specialists. Results: Across the 320 areas (95%) recording treatments, a median 76 (interquartile range [IQR] 35-207, range 4-3834) per 100,000 were initiated, corresponding to an estimated median 7.9% (IQR 2.9-23.6%, range 0-100%) treatment uptake. Major cities, areas of socioeconomic advantage and areas with lower proportions of the population born overseas had the highest per capita treatment rates. Non-specialists prescribed 46% (20,323/44,382) of treatment initiations. Prescriptions were written by non-specialists only in 163 areas (51%), while in other areas a median 40.0% (IQR 21.8-62.5%) of prescriptions were written by non-specialists. Non-specialist prescribing was higher in regional areas, as well as areas that had greater proportions of Indigenous Australians. Conclusions: High national-level treatment uptake of 20% in Australia masks underlying health system limitations; more than half of geographical areas may have treated less than 8% of people living with HCV. Areas of socioeconomic disadvantage and areas with a higher proportion of the population born overseas may need targeting with interventions to improve treatment uptake.

Link to open access full text on Pubmed Central

JD, MH, and the Burnet Institute receive investigator-initiated research funding from Gilead Sciences, AbbVie and BMS. JD‘s institution has received honoraria from Merck, Gilead and BMS. No pharmaceutical grants were received in the development of this study. AP, JD, MH and RSD are the recipients of National Health and Medical Research Council fellowships. The authors gratefully acknowledge the support provided to the Burnet Institute by the Victorian Government