Hepatitis C direct-acting antiviral treatment completion: Comparison of geographic, demographic and clinical characteristics in Australia

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Background and objectiveHepatitis C virus treatment uptake varies by geographic area in Australia; however, analysis has not been conducted on variations in treatment completion.This study investigated treatment completion according to remoteness, as well as demographic and clinical characteristics. MethodsA retrospective analysis was conducted on all Pharmaceutical Benefits Scheme claim data from March 2016 to June 2019.Treatment was considered completed if all prescriptions required to complete the course were dispensed.Treatment completion was compared by remoteness of residence, sex, age, state or territory, treatment duration and prescriber type. ResultsOf 68,940 patients, 85.6% completed treatment, although the completion rate decreased over time.Residents living in very remote areas had the lowest treatment completion rate (74.3%; odds ratio [OR] 0.52; 95% confidence interval [CI]: 0.39, 0.7; P < 0.005), particularly those treated by general practitioners (GPs; 66.7%; OR 0.47; 95% CI: 0.22, 0.97; P = 0.042). DiscussionThis analysis suggests that people in very remote areas of Australia have the lowest hepatitis C treatment completion rate, particularly those accessing treatment through GPs.Further investigation into predictors of low treatment completion within these populations is required.IN MARCH 2016, new direct-acting antivirals (DAAs) for chronic hepatitis C virus (HCV) were added to the Pharmaceutical Benefits Scheme (PBS) and replaced interferon-based therapies as first-line treatment.1 Prior to this, DAAs were only available through pharmaceutical trials. 2 DAAs are oral therapies with fewer side effects, shorter treatment duration and a greater than 90% cure rate. 2 It was estimated that 188,770 Australians were living with HCV at the start of 2016, 3 and approximately half were treated by the end of 2020. 4 This is linked to an approximate 20% decline in deaths from HCV-related liver failure and hepatocellular carcinoma, in contrast to previous trends.5 However, yearly treatment numbers have decreased over time, from 32,049 in 2016 to 8140 during 2020, and more than 300 individuals still die due to HCV each year in Australia.4 A recent study estimated that HCV testing and treatment in Australia needs to increase by 50% to meet the World Health Organization targets for elimination.6 The prevalence of HCV is estimated to be higher in rural and regional areas than in metropolitan areas.4 Treatment uptake also varies by region, and has been highest in inner regional areas and lowest in remote and very remote areas.4 Similarly, health service access varies by remoteness, and HCV DAAs in particular have high cost outlays that may limit availability in pharmacies outside of major centres.7,8 Currently, there are no population-level analyses of treatment completion in Australia, and uptake measures are generally based on initiations that do not account for cessation prior to completion.4,9 The aim of this study was to explore disparities in HCV treatment completion according to various factors, using PBS dispensing data.The Australasian Hepatology Association consensus guidelines recommend dispensing records as an evidence-based method of evaluating DAA treatment completion, 10 and a similar approach has previously been used in the Australian context for hepatitis B. 11 In this study, we analysed PBS claims, which cover all Australians provided Hepatitis C direct-acting antiviral treatment completion Comparison of geographic, demographic and clinical characteristics in Australia

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