Hajarizadeh B, Grebely J, Matthews G V, Martinello M, Dore G J
The Kirby Institute, UNSW Sydney, Sydney, NSW, Australia.
J Viral Hepat. 2018 Jun;25(6):640-648. doi: 10.1111/jvh.12852. Epub 2018 Feb 19.
A government-funded interferon-free direct-acting antiviral (DAA) treatment programme for chronic hepatitis C virus (HCV) infection has been available in Australia since March 2016. This study assessed the levels and patterns of DAA treatment uptake during March-December 2016 in Australia and described the key features in the development of the programme. All prescriptions in Australia are submitted to the Pharmaceutical Benefits Scheme by dispensing pharmacies. Data on dispensed DAA prescriptions for a longitudinal cohort of individuals, representing a 10% random sample of the Pharmaceutical Benefits Scheme database, were used for estimating DAA treatment uptake and subgroup analyses. The estimated number of 32 400 individuals initiated DAA treatment in 2016, equating to 14% of people with chronic HCV infection in Australia. Most commonly prescribed DAA regimens included sofosbuvir/ledipasvir (56%, n = 18 020), sofosbuvir + daclatasvir (39%, n = 12 600) and sofosbuvir + other agents (4%, n = 1220). Among individuals initiated DAA treatment, 66% (n = 21 430) were men, 43% (n = 13 870) were ≤50 years old and 36% (n = 11 670) had cirrhosis. DAA prescriptions were 62% (n = 20 080) by specialists, 19% (n = 6000) by general practitioners (GP) and 20% (n = 6320) by other physicians. Proportion of individuals prescribed DAA by GPs increased from 8% to 31% and proportion of individuals ≤50 years old increased from 28% to 61% between March and December. In conclusion, rapid treatment scale-up was observed in the first 10 months of unrestricted DAA programme in Australia. The proportion of prescriptions by GPs increased over time, important for broadened access. A trend towards younger age treatment suggested the broadening of DAA-treated population, potentially including individuals at higher risk of HCV transmission.
自2016年3月起，澳大利亚就有了一项由政府资助的针对慢性丙型肝炎病毒（HCV）感染的无干扰素直接抗病毒（DAA）治疗项目。本研究评估了2016年3月至12月期间澳大利亚DAA治疗的接受水平和模式，并描述了该项目发展过程中的关键特征。澳大利亚所有的处方都由配药药房提交给药品福利计划。针对代表药品福利计划数据库10%随机样本的纵向队列个体的已配药DAA处方数据，用于估计DAA治疗的接受情况和亚组分析。2016年估计有32400人开始接受DAA治疗，相当于澳大利亚慢性HCV感染患者的14%。最常开具的DAA治疗方案包括索磷布韦/维帕他韦（56%，n = 18020）、索磷布韦+达拉他韦（39%，n = 12600）和索磷布韦+其他药物（4%，n = 1220）。在开始接受DAA治疗的个体中，66%（n = 21430）为男性，43%（n = 13870）年龄≤50岁，36%（n = 11670）患有肝硬化。DAA处方由专科医生开具的占62%（n = 20080），由全科医生（GP）开具的占19%（n = 6000），由其他医生开具的占20%（n = 6320）。3月至12月期间，由全科医生开具DAA处方的个体比例从8%增加到31%，年龄≤50岁的个体比例从28%增加到61%。总之，在澳大利亚DAA项目不受限制的前10个月里，观察到治疗规模迅速扩大。全科医生开具处方的比例随时间增加，这对于扩大治疗可及性很重要。治疗年龄趋于年轻化表明接受DAA治疗的人群在扩大，可能包括HCV传播风险较高的个体。
