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Uptake of and Expenditure on Direct-Acting Antiviral Agents for Hepatitis C Treatment in Australia

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Abstract

Background

Direct-acting antiviral agents (DAAs) have revolutionised treatment for the hepatitis C virus (HCV). Currently, treatment costs between 20,000 and 80,000 Australian dollars ($A) per patient. The Australian Federal Government provided $A1 billion over 5 years to subsidise these drugs.

Objective

The aim of this paper was to evaluate the uptake and financial impact of DAA prescribing in Australia.

Methods

We undertook a retrospective analysis of Medicare prescription and expenditure data for March 2016 to August 2017. Prescription numbers and expenditure data were extracted from the Medicare Statistical Reports website. Numbers of prescriptions were converted to per capita rates. HCV prevalence measures were used to provide context to prescription rates. All costs were reported in $A, year 2017 values.

Results

Nationally, 211,184 DAA prescriptions were reimbursed. Whilst $A3.6 billion was expended through the Pharmaceutical Benefits Scheme, confidential pricing agreements precluded calculation of the precise cost. In 18 months, estimated expenditure greatly exceeded the $A1 billion in funding for 5 years. Nationally, the rate of prescriptions was 872/100,000 individuals. Prescription rates were highest in the Australian Capital Territory (1087/100,000) and lowest in Western Australia (625/100,000) despite HCV prevalence being comparable to the national rate in both regions.

Conclusions

Uptake of DAAs has been enthusiastic in the first 18 months of this funding agreement. However, the lack of transparency due to the confidential special pricing agreements means actual government expenditure is unknown. Post-marketing review by the Pharmaceutical Benefits Advisory Committee may enable renegotiation of DAA prices with the sponsors.

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Data Availability Statement

The datasets analysed during this study are available as follows: prescription numbers and expenditure data are available from http://medicarestatistics.humanservices.gov.au/statistics/pbs_item.jsp. Prevalence data are publicly available from the Australian Department of Health’s National Notifiable Diseases Surveillance System, accessible via http://www9.health.gov.au/cda/source/cda-index.cfm. Prevalence data for PWID were extracted from the Kirby Institute’s Annual Surveillance Report on HIV, Viral Hepatitis and STIs in Australia: https://kirby.unsw.edu.au/report/annual-surveillance-report-hiv-viral-hepatitis-and-stis-australia-2017.

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Author information

Authors and Affiliations

  1. Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia

    Barbara de Graaff & Andrew Palmer

  2. School of Medicine, University of Tasmania, Hobart, Australia

    Kwang Chien Yee

  3. School of Population and Global Health, University of Melbourne, Parkville, Australia

    Philip Clarke

Authors
  1. Barbara de Graaff
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  2. Kwang Chien Yee
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  3. Philip Clarke
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  4. Andrew Palmer
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Contributions

BdG conceptualised the paper, conducted the analyses and prepared the manuscript. KCY provided clinical expertise and assisted with preparing and revising the manuscript. PC and AP provided health economics expertise and assisted with preparing and revising the manuscript.

Corresponding author

Correspondence to Barbara de Graaff.

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Funding

No sources of funding were used to conduct this study or prepare this manuscript.

Conflict of interest

Barbara de Graaff, Kwang Chien Yee, Philip Clarke and Andrew Palmer have no conflicts of interest that are directly relevant to the content of this manuscript.

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de Graaff, B., Yee, K.C., Clarke, P. et al. Uptake of and Expenditure on Direct-Acting Antiviral Agents for Hepatitis C Treatment in Australia. Appl Health Econ Health Policy 16, 495–502 (2018). https://doi.org/10.1007/s40258-018-0392-8

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  • DOI: https://doi.org/10.1007/s40258-018-0392-8

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