(61) The Impact of Expanded Access to Direct Acting Antivirals for Hepatitis C on Patient Outcomes in Canada

Publication Number: 735

Background: Hepatitis C virus (HCV) is a serious condition with high global prevalence. HCV can lead to liver complications and death. The introduction of direct acting antivirals (DAAs) has advanced treatment for HCV due to its high cure rates of over 95%. However, high costs of DAAs are barriers to treatment, prompting national negotiations in Canada to reduce pricing and improve access. Consequently, in 2015 and 2017, policies were implemented allowing DAAs to be widely available, leading to increases in DAA utilization. However, the real-world impact of expanded DAA access is unknown.

Objectives: To determine the early change in volumes of hospitalizations associated with liver disease and hepatocellular carcinoma (HCC) after expanded DAA access.

Methods: We conducted a population-based time series analysis using national administrative databases in Canada from the Canadian Institute for Health Information, including data from all provinces and territories except Quebec. The number of hospitalizations associated with liver disease and HCC were identified monthly and yearly, respectively, between April 2006 and March 2020. We used Autoregressive Integrated Moving Average (ARIMA) models to assess the trends for each outcome, with ramp functions at 2015 and 2017 denoting the two timepoints during which policies were implemented to expand DAA access. Volumes were analyzed for the overall national population and by age group.

Results: Hospitalizations due to liver disease increased steadily in Canada from 2006 to 2020 (average 5756 admissions per month), with no significant changes in 2015 or 2017. Volumes were highest in those aged 65+ (29,689 per year) and lowest in the age < 30 group (3296 per year). Hospitalizations increased in 2015 for those aged 30-49 (p=0.0149), but ages 50-64 saw volumes plateau in 2015 (p <.0001) and 2017 (p=0.0068). HCC-specific hospitalizations also generally increased during this time (average 225 cases per month), but a significant drop was found in 2017 (p=0.0288). Admissions were highest among those aged 50-64 (1147 per year) and 65+ (1390 per year). Ages 30-49 saw a decrease in 2015 (p=0.0033) followed by an increase in 2017 (p=0.0161), while ages 50-64 experienced reductions in 2015 (p=0.0073).

Conclusions: Expanding DAA access led to fewer HCC-specific hospitalizations in the overall population but had no apparent effect on hospitalizations for liver disease yet. Importantly, significant reductions were observed in the age 50-64 age group. In light of the time required for HCV-related complications to manifest, continued ongoing research examining the real-world effectiveness of DAAs is required.