乙肝抗病毒治疗的吸收情况：中国31个省份的面板数据分析（

StephenW

乙肝抗病毒治疗的吸收情况：中国31个省份的面板数据分析（2013-2020）
郑汉超 1 , 刘诗洋 2 , 罗西门 3 , 陈波琳 4 , 陈中丹 5 , 乐林维 4 , 孙静 1
隶属关系
隶属关系

    1
    中国医学科学院北京协和医学院卫生政策与管理学院，中国北京。
    2
    中国人民解放军医学院/解放军总医院第五医学中心，北京，中国。
    3
    IQVIA 控股公司，中国北京。
    4
    肝炎/结核病/艾滋病毒/性病，世界卫生组织西太平洋区域办事处，菲律宾马尼拉。
    5
    肝炎/结核病/艾滋病毒/性病，世界卫生组织中国代表处，中国北京。

    PMID: 35615902 DOI: 10.1111/liv.15321

抽象的

背景：中国为促进乙型肝炎（HB）抗病毒治疗的普及做出了巨大努力。目前尚不清楚这些政策是否达到了预期的效果。本研究采用 31 个省份的药品采购数据，初步生成了中国国家和省级 HB 加班标准抗病毒治疗数量的证据。

方法：我们采用时变差值法结合事件研究法进行面板数据分析和准实验设计，以估计国家政策变化前后 HB 抗病毒治疗的吸收情况。

结果：2013-2020 年间，国家层面 HB 抗病毒治疗的总体趋势呈递增趋势。 2020年12个月（人-年）抗病毒标准治疗288.62万人次，仅占预计需要治疗的符合条件人群的8.93%。 2019年全国实行“4+7”集中采购价格试点后，月度抗病毒药物标准治疗量总体增长42.4%（P=0.001），带动核心抗病毒药物大幅降价。

结论：低治疗率是中国消除病毒性肝炎这一公共卫生威胁的关键问题。负担能力是决定接受肝炎治疗的一个重要但不是唯一的因素。进一步扩大和加速治疗需要采取战略来提高公众对 HB 的认识，加强诊断，将感染者与慢性护理联系起来，减少随访损失，并确保符合条件的人得到及时治疗。

关键词：中国；抗病毒治疗；乙型肝炎；政策影响分析；治疗吸收。

StephenW

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.

Keywords: China; antiviral treatment; hepatitis B; policy impact analysis; treatment uptake.