Institute for Health System Solutions and Virtual Care, Women's College Hospital, Toronto, ON, Canada.
Unity Health Toronto, Toronto, ON, Canada.
PLoS One. 2023 Aug 8;18(8):e0284914. doi: 10.1371/journal.pone.0284914. eCollection 2023.
Hepatitis C virus (HCV) has high global prevalence and can lead to liver complications and death. Access to direct-acting antivirals (DAAs) in Canada increased following several policy changes, however the real-world impact of expanded DAA access and increased use of these drugs is unknown.
We aimed to determine the early change in rates of HCV-related hospitalizations overall and HCV-related hospitalizations with hepatocellular carcinoma (HCC) after expanded DAA access.
We conducted a population-based time series analysis using national administrative health databases in Canada. Rates of HCV-related hospitalizations and HCV-related hospitalizations with HCC were enumerated monthly between April 2006 and March 2020. We used Autoregressive Integrated Moving Average (ARIMA) models with ramp functions in October 2014 and January 2017 to evaluate the impact of policies to expand DAA access on hospitalization outcomes.
Rates of HCV-related hospitalizations in Canada increased between 2006 and 2014, and gradually declined thereafter. The decrease after October 2014, or the first policy change, was significant (p = 0.0355), but no further change was found after the second policy change in 2017 (p = 0.2567). HCV-related hospitalizations with HCC increased until end of 2013, followed by a plateau, before declining in 2016. No significant shifts were found after the first policy change in 2014 (p = 0.1291) nor the second policy change in 2017 (p = 0.6324). Subgroup analyses revealed that those aged 50-64 and males had observable declines in rates of HCV-related hospitalizations in the year prior to the first policy change.
Expanding DAA access was associated with a drop in HCV-related hospitalizations in the overall Canadian population coinciding with the 2014 policy change. In light of the time required for HCV-related complications to manifest, continued ongoing research examining the real-world effectiveness of DAAs is required.
丙型肝炎病毒（HCV）在全球的流行率很高，可导致肝脏并发症和死亡。在加拿大，随着几项政策的改变，直接作用抗病毒药物（DAA）的可及性有所提高，然而，扩大 DAA 可及性和增加这些药物的使用对现实世界的影响尚不清楚。
我们旨在确定扩大 DAA 可及性后，总体上 HCV 相关住院率以及伴有肝细胞癌（HCC）的 HCV 相关住院率的早期变化。
我们使用加拿大国家行政健康数据库进行了一项基于人群的时间序列分析。2006 年 4 月至 2020 年 3 月期间，每月对 HCV 相关住院率和伴有 HCC 的 HCV 相关住院率进行计数。我们使用带斜坡函数的自回归综合移动平均（ARIMA）模型在 2014 年 10 月和 2017 年 1 月评估了扩大 DAA 可及性的政策对住院结局的影响。
加拿大 HCV 相关住院率在 2006 年至 2014 年期间增加，此后逐渐下降。2014 年 10 月（第一次政策变化）后的下降具有显著意义（p = 0.0355），但 2017 年（第二次政策变化）后未发现进一步变化（p = 0.2567）。伴有 HCC 的 HCV 相关住院率在 2013 年底前增加，随后达到平台期，然后在 2016 年下降。2014 年第一次政策变化（p = 0.1291）和 2017 年第二次政策变化（p = 0.6324）后均未发现显著变化。亚组分析显示，在第一次政策变化前一年，50-64 岁年龄组和男性的 HCV 相关住院率出现了可观察到的下降。
扩大 DAA 可及性与 2014 年政策变化时加拿大总人口中 HCV 相关住院率的下降有关。鉴于 HCV 相关并发症表现所需的时间，需要继续开展研究以评估 DAA 的真实世界效果。
