Uptake of hepatitis B antiviral treatment: a panel data analysis of 31 provinces in China (2013-2020)
Hanchao Cheng 1 , Shiyang Liu 2 , Simon Luo 3 , Polin Chan 4 , Zhongdan Chen 5 , Linh-Vi Le 4 , Jing Sun 1
Affiliations
Affiliations
1
School of Health Policy and Management, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, P.R. China.
2
Medical School of Chinese PLA/The Fifth Medical Center of PLA General Hospital, Beijing, P.R. China.
3
IQVIA Holding Company, Beijing, P.R. China.
4
Hepatitis/TB/HIV/STI, World Health Organisation Regional Office for the Western Pacific, Manila, Philippines.
5
Hepatitis/TB/HIV/STI, World Health Organization Representative Office in China, Beijing, P.R. China.
PMID: 35615902 DOI: 10.1111/liv.15321
Abstract
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 of 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 were 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=0.001) overall following the nationwide adoption of the '4+7' pilot pooled procurement prices in 2019, which brought substantial price reduction of core antivirals.
Conclusions: 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 to improve 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.