At the beginning of 2016 the Australian government announced
that it would fund DAA treatment for anyone with hepatitis
C, regardless of liver disease stage. The decision followed extensive
campaigning by patient groups and negotiations with the pharmaceutical industry
that resulted in an innovative pricing agreement. In return for committing to
spend $1 billion on DAAs over three years, manufacturers agreed to provide
treatment for that sum to everyone who sought treatment during that period.
Liver specialists and patient groups expected high demand,
reflecting years of pent-up demand for treatment in Australia, but the pace of
uptake has surprised everyone. In a poster presentation at The Liver Meeting,
Behzad Hajarizadeh and colleagues at the Kirby Institute presented estimates of
treatment uptake during the first five months of availability of DAAs through
Australia’s Pharmaceutical Benefits Scheme (PBS), which covers almost all the cost of
prescribed medicines for Australian citizens.
Data were gathered from PBS
records and wholesale drug expenditure figures, and used to estimate the number
of people starting treatment and the distribution of treated people across
Australian states. The study also looked at which types of prescribers were
initiating people on treatment.
As its baseline, the study assumed that around 227,000
people were living with diagnosed HCV in March 2016. Analysis of the PBS
records found that 18,581 people started treatment during the first five months
of DAA availability, but due to the time lag between prescription filling and
processing of the claim by the PBS, the number who started treatment was much
higher. Analysing the amount of money spent on medication led the researchers
to estimate that around 26,000 had begun treatment during the 5-month period
(although this figure could be as high as 30,415 or as low as 22,304).
In March and April 2016 around 7000 people in each month
started treatment. In subsequent months the numbers starting treatment fell
below 4000 per month. The researchers estimate that around 12% of people with
hepatitis C had begun treatment by the end of July 2015, although the
proportion treated appears lower in Western Australia (7%) and Northern
Fifty-eight per cent of people started treatment with
sofosbuvir/ledipasvir (Harvoni), and
in the vast majority of cases this was a 12-week treatment course.
Sofosbuvir/daclatasvir was prescribed in 38% of cases.
Paritaprevir/ritonavir/ombitasvir and dasabuvir (Viekirax) was prescribed to only 1% of people.
Taking into account people previously treated through
clinical trials or early access programmes, and those who obtained generics,
the researchers estimate that two-thirds of people with cirrhosis have already
begun treatment, the vast majority since March 2016.