Uptake of hepatitis B antiviral treatment: A panel data analysis of 31 provinces in China (2013–2020)

Abstract

Background: China has made substantial efforts aimed to promote the uptake of antiviral treatment of hepatitis B (HB). It is unclear whether these policies achieved the desired impact. This study adopted medicines procurement data from 31 provinces to generate the first evidence about the number of standard antiviral treatment of HB overtime at both national and provincial levels in China. Methods:We performed the panel data analyses and quasi-experimental design with the time-varying difference-in-difference method combined with the event study approach to estimate the uptake of HB antiviral treatment before and after national policy changes. Results:The overall trends in HB antiviral treatment at the national level increased incrementally during 2013-2020. There was 2.8862 million 12-month (person-year) antiviral standard treatment in 2020, which was only 8.93% of the eligible people estimated to need treatment. The number of monthly antiviral standard treatment increased by 42.4% (p = .001) overall following the nationwide adoption of the '4 + 7' pilot-pooled procurement prices in 2019, which brought substantial price reduction of core antivirals. Conclusions:A low treatment rate is a critical issue in reaching the elimination of viral hepatitis as a public health threat in China. Affordability is an important but not the only factor that determines the uptake of hepatitis treatment. Further scaling up and acceleration of treatment uptake will need strategies improving public awareness of HB, strengthening diagnosis, linking people who are infected to chronic care, reducing loss to follow-up, and ensuring people who are eligible get timely treatment.

Characteristics of patients with chronic hepatitis B infection in China: A retrospective claims database study

“…This study found that approximately two-thirds of patients with CHB were receiving anti-HBV therapy, which exceeds recent estimates of treatment uptake among patients with CHB in China [ 34 ] and globally. [ 1 , 35 ] While this study was conducted using the CHIRA database and is subject to specific limitations, which are discussed later, this may reflect the level of compliance with treatment guidelines by physicians or the accessibility of anti-HBV treatment through medical insurance coverage; it may also be indicative of the current level of patient education and treatment adherence.…”

“…Recent evidence suggests that use of tenofovir in China is increasing, with a corresponding decrease in the use of first-generation NAs such as lamivudine, telbivudine, and adefovir dipivoxil. [34] This study also aimed to compare patient characteristics and treatment patterns in Tier III versus Tier I/II hospitals. Our findings highlight key differences between patients with CHB who visited Tier III hospitals and those who visited Tier I/II hospitals.…”

“…Recent evidence suggests that use of tenofovir in China is increasing, with a corresponding decrease in the use of first-generation NAs such as lamivudine, telbivudine, and adefovir dipivoxil. [ 34 ]…”

“…Mean (SD) outpatient cost per capita was 6170 (7895) Chinese yuan (CNY) (1 CNY = 0.1506 United States dollars, 2016) for patients with cirrhosis and 4160 (4993) CNY for patients without cirrhosis. Hospitalizations were experienced by 57.83% of patients with cirrhosis and 29.84% of those without cirrhosis; the mean (SD) frequency of admissions per capita was 1.76 (1.47) and 1.57 (1.83), respectively, and the mean (SD) hospitalization cost per capita was 25,570(34,567)…”