Department of Infectious Disease Epidemiology, Robert Koch Institute, Berlin, Germany.
Division of Hepatology, Department of Medicine II, Leipzig University Medical Center, Leipzig, Germany.
Front Public Health. 2021 May 21;9:667253. doi: 10.3389/fpubh.2021.667253. eCollection 2021.
Germany is a low prevalence country for hepatitis B virus (HBV) infection with higher prevalence in vulnerable groups. The number of treated chronic hepatitis B (CHB) patients is unknown. We aimed to determine the number of CHB patients treated with nucleos(t)ide analogs (NUCs), the treatment costs within the statutory health insurance (SHI) in Germany and per patient per month. Data on pharmacy bills of NUCs to patients with SHI between 2008 and 2019 were purchased from Insight Health™ and described. Negative binomial regression was used for trend analysis. Number of patients increased between 2008 and 2019 (4.9% per year) with little changes in treatment options. Overall prescription costs were increasing (6.7% per year on average) until the introduction of tenofovir and entecavir generics in 2017 after which costs decreased by 31% in 2019. Average therapy costs peaked at 498 Euro per patient per month in 2016 and decreased to 214 Euro in 2019. Prescriptions changed from 30 to 90 pills per pack over time. HBV therapy was prescribed to 97% by three medical specialist groups, mainly specialists in internal medicine (63%), followed by hospital-based outpatient clinics (20%) and general practitioners (15%). Contrary to guideline recommendation, adefovir was still prescribed after 2011 for 1-5% of patients albeit with decreasing tendency. Prescriptions per 100,000 inhabitants were highest in Berlin and Hamburg. Our data shows, that the number of treated CHB patients increased steadily, while NUC therapy costs decreased. We recommend continued testing and treatment for those eligible to prevent advanced liver disease and possibly decrease further transmission of HBV.
德国是乙型肝炎病毒 (HBV) 感染的低流行国家，在弱势群体中感染率较高。接受治疗的慢性乙型肝炎 (CHB) 患者人数未知。我们旨在确定在德国接受核苷（酸）类似物 (NUC) 治疗的 CHB 患者人数、法定健康保险 (SHI) 内的治疗费用以及每位患者每月的费用。从 Insight Health™购买了 2008 年至 2019 年接受 SHI 的 NUC 患者的药房账单数据，并进行了描述。使用负二项回归进行趋势分析。2008 年至 2019 年间，患者人数增加（每年 4.9%），治疗选择变化不大。总体处方费用呈上升趋势（平均每年增长 6.7%），直到 2017 年替诺福韦和恩替卡韦仿制药上市后，2019 年费用下降了 31%。平均治疗费用在 2016 年达到每位患者每月 498 欧元的峰值，2019 年降至 214 欧元。随着时间的推移，每个包装的处方从 30 片增加到 90 片。HBV 治疗主要由三个医学专科小组开具，主要是内科专家（63%），其次是医院门诊（20%）和全科医生（15%）。尽管有下降趋势，但 2011 年后仍有 1-5%的患者开具阿德福韦，违反了指南建议。柏林和汉堡的每 10 万居民处方数最高。我们的数据表明，接受治疗的 CHB 患者人数稳步增加，而 NUC 治疗费用下降。我们建议继续对符合条件的患者进行检测和治疗，以预防晚期肝病，并可能进一步减少 HBV 的传播。
