(104) Uptake of Antiviral Treatment of Chronic Hepatitis B: A Panel Data Analysis of 31 Provinces in China (2013-2020)

Saturday, August 27, 2022

8:00 AM – 6:00 PM CEST

Location: Hall C

Publication Number: 778

Presenting Author(s)

Hanchao Cheng
– School of Health Policy and Management, Chinese Academy of Medical Sciences and Peking Union Medical College, China (People's Republic)

Co-Author(s)

Shiyang Liu
– Beijing, Beijing, China
Simon Luo
– IQVIA, China, China (People's Republic)
Linh-Vi Le
– World Health Organisation Western Pacific Region, Philippines
Zhongdan Chen
– World Health Organisation China, China (People's Republic)
Polin Chan
– World Health Organisation Western Pacific Region, Philippines
Jing SUN
– Davao Regional Medical Center, Beijing, Beijing, China

Background: China has made unremitting efforts aimed to promote uptake of antiviral treatment of chronic hepatitis B (CHB). It is unclear whether these policies achieve the desired effects. Measuring and analyzing antiviral treatment will enable verification of the expected effects, and to inform evidence-based policymaking of a more effective response to hepatitis B in China.

Objectives: To evaluate the effect of policies which aim to improve the accessibility and affordability of NAs in China from 2013 to 2020.

Methods: We performed year panel data analyses of the number of 12-month standard nucleoside/nucleotide analogues (NAs) treatment of CHB in 31 provinces from 2013 to 2020 based on IQVIA’s China Hospital Pharmaceutical Audit medicines procurement dataset. We adopted a quasi-experimental study design with the time-varying difference-in-difference method combined with the event study approach to estimate the overall and dynamic effects of stepwise adoption of “4+7” pilot pooled procurement prices in 31 provinces in China on the monthly number of NA treatment of CHB from March to November 2019.

Results: Antiviral treatment of CHB continuously increased during 2013-2020 at the national level. There were 2·8862 million 12-month standard NA treatment of CHB in 2020, which was only 8·93% of the eligible, far below the WHO target of 80%. Compared with non-adoption status, adoption of “4+7” pooled procurement prices brought the number of monthly NA standard treatment of CHB increased by 42·35% (0.4235=e0·3531-1, P=0.001) overall with the province and time fixed-effect model. In the month of price adoption, the number of monthly NA standard treatment of CHB increased by 24·66% (0·2466=e0·2204-1, P=0·004). 4 months after the price adoption in 10 provinces which proceeded earlier, the number of monthly NA treatment of CHB increased by 31·47% (0·3147=e0·2736-1, P=0·001).

Conclusions: Low treatment rate has become an increasingly critical barrier for China to achieve the elimination goal. Affordability of treatment is not the only determinant to improve access and uptake of hepatitis treatment. Considering that current costs of NA treatment of CHB in China have been reduced to the lowest international level, there is not much space for further affordability improvement, scale-up of NA treatment of CHB would need other strategies next step. Further priorities for actions towards HBV elimination would attach importance to the cascade of care for CHB. Enhancing public awareness, identifying the missing people who are infected and unaware and who may need treatment through targeted screening and diagnosis with operational mechanism and operating procedures.