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Uptake of hepatitis B antiviral treatment: A panel data analysis of 31 provinces in China (2013-2020)
Hanchao Cheng1, Shiyang Liu2, Simon Luo3
1School of Health Policy and Management, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, P. R. China.
Insights
China
Area of Science:
- Hepatology and Viral Hepatitis Research
- Public Health Policy and Intervention
- Pharmaceutical Procurement and Access
Background:
- National policies in China aimed to increase antiviral treatment for hepatitis B (HB).
- The impact of these policies on HB antiviral treatment uptake remains unclear.
- This study provides the first evidence on national and provincial HB antiviral treatment trends in China.
Purpose of the Study:
- To evaluate the effectiveness of national policies in promoting hepatitis B antiviral treatment uptake in China.
- To analyze trends in HB antiviral treatment from 2013-2020 using procurement data.
- To assess the impact of pooled procurement prices on treatment accessibility.
Main Methods:
- Utilized medicines procurement data from 31 Chinese provinces.
- Employed panel data analysis and quasi-experimental design.
- Applied time-varying difference-in-difference and event study approaches to analyze policy impact.
Main Results:
- National hepatitis B antiviral treatment increased incrementally from 2013-2020.
- In 2020, 2.8862 million person-years of treatment were provided, reaching only 8.93% of eligible individuals.
- A 42.4% increase in monthly treatment occurred after the 2019 '4+7' pooled procurement policy, significantly reducing core antiviral prices.
Conclusions:
- Low hepatitis B treatment rates pose a challenge to viral hepatitis elimination in China.
- While affordability is key, other factors like awareness, diagnosis, and care linkage are crucial for increasing treatment uptake.
- Strategies to improve public awareness, diagnosis, chronic care, and reduce follow-up loss are needed to accelerate treatment.
Background:
China has made substantial efforts aimed to promote the uptake of antiviral treatment of hepatitis B (HB). It is unclear whether these policies achieved the desired impact. This study adopted medicines procurement data from 31 provinces to generate the first evidence about the number of standard antiviral treatment of HB overtime at both national and provincial levels in China.
Methods:
We performed the panel data analyses and quasi-experimental design with the time-varying difference-in-difference method combined with the event study approach to estimate the uptake of HB antiviral treatment before and after national policy changes.
Results:
The overall trends in HB antiviral treatment at the national level increased incrementally during 2013-2020. There was 2.8862 million 12-month (person-year) antiviral standard treatment in 2020, which was only 8.93% of the eligible people estimated to need treatment. The number of monthly antiviral standard treatment increased by 42.4% (p = .001) overall following the nationwide adoption of the '4 + 7' pilot-pooled procurement prices in 2019, which brought substantial price reduction of core antivirals.
Conclusions:
A low treatment rate is a critical issue in reaching the elimination of viral hepatitis as a public health threat in China. Affordability is an important but not the only factor that determines the uptake of hepatitis treatment. Further scaling up and acceleration of treatment uptake will need strategies improving public awareness of HB, strengthening diagnosis, linking people who are infected to chronic care, reducing loss to follow-up, and ensuring people who are eligible get timely treatment.
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