Variable access to antiviral treatment of chronic hepatitis B in Canada: a descriptive study.

Journal

CMAJ open
ISSN: 2291-0026
Titre abrégé: CMAJ Open
Pays: Canada
ID NLM: 101620603

Informations de publication

Date de publication:
Historique:
entrez: 31 3 2019
pubmed: 31 3 2019
medline: 31 3 2019
Statut: epublish

Résumé

Antiviral treatment for chronic hepatitis B is costly, which presents challenges for universal drug coverage for the estimated 480 000 people with the disease in Canada. We appraised criteria for reimbursement of chronic hepatitis B antivirals by public drug plans in Canada. In this descriptive study, we reviewed the reimbursement criteria for lamivudine, adefovir, tenofovir, entecavir, telbivudine, pegylated or standard interferon, and emtricitabine-tenofovir in the 10 provinces and the Yukon Territory as well as 3 federal programs: Correctional Services Canada, Veterans' Affairs and the Non-Insured Health Benefits Program. We extracted data from publicly available formularies. The primary outcomes extracted were prescriber details, reimbursement regulations and published list price. All public drug insurance plans limit access to antiviral treatment in patients with chronic hepatitis B based on viral characteristics, fibrosis stage and/or specialist approval. Lamivudine use is restricted only in British Columbia and Ontario. Six plans (43%) cover entecavir or tenofovir with no restriction, and 8 plans (57%) cover these agents if patients have advanced fibrosis/cirrhosis. Nine plans (64%) provide coverage of interferon, although 4 of these programs reimburse only nonpegylated interferon, which is not currently recommended for chronic hepatitis B treatment. We found substantial variability among jurisdictions in reimbursement criteria for the treatment of chronic hepatitis B in Canada. The findings can inform health policy and support the development and adoption of a national chronic hepatitis B strategy to ensure equitable and timely access to treatment no matter where patients reside in Canada.

Sections du résumé

BACKGROUND BACKGROUND
Antiviral treatment for chronic hepatitis B is costly, which presents challenges for universal drug coverage for the estimated 480 000 people with the disease in Canada. We appraised criteria for reimbursement of chronic hepatitis B antivirals by public drug plans in Canada.
METHODS METHODS
In this descriptive study, we reviewed the reimbursement criteria for lamivudine, adefovir, tenofovir, entecavir, telbivudine, pegylated or standard interferon, and emtricitabine-tenofovir in the 10 provinces and the Yukon Territory as well as 3 federal programs: Correctional Services Canada, Veterans' Affairs and the Non-Insured Health Benefits Program. We extracted data from publicly available formularies. The primary outcomes extracted were prescriber details, reimbursement regulations and published list price.
RESULTS RESULTS
All public drug insurance plans limit access to antiviral treatment in patients with chronic hepatitis B based on viral characteristics, fibrosis stage and/or specialist approval. Lamivudine use is restricted only in British Columbia and Ontario. Six plans (43%) cover entecavir or tenofovir with no restriction, and 8 plans (57%) cover these agents if patients have advanced fibrosis/cirrhosis. Nine plans (64%) provide coverage of interferon, although 4 of these programs reimburse only nonpegylated interferon, which is not currently recommended for chronic hepatitis B treatment.
INTERPRETATION CONCLUSIONS
We found substantial variability among jurisdictions in reimbursement criteria for the treatment of chronic hepatitis B in Canada. The findings can inform health policy and support the development and adoption of a national chronic hepatitis B strategy to ensure equitable and timely access to treatment no matter where patients reside in Canada.

Identifiants

DOI: 10.9778/cmajo.20180108 PMID: 30926602 PMC: PMC6440881
pubmed: 30926602
pii: 7/1/E182
doi: 10.9778/cmajo.20180108
pmc: PMC6440881
doi:

Types de publication

Journal Article

Langues

eng

Pagination

E182-E189

Informations de copyright

Copyright 2019, Joule Inc. or its licensors.

Déclaration de conflit d'intérêts

Competing Interests: Stephen Congly reports grants from Allergan, Boehringer Ingelheim, Bristol-Myers Squibb, Genfit and Gilead Sciences outside the submitted work. No other competing interests were declared.

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Auteurs

Stephen E Congly (SE)

University of Calgary Liver Unit (Congly), Division of Gastroenterology and Hepatology, Department of Medicine, University of Calgary, Calgary, Alta.; Division of Gastroenterology, Department of Medicine, and Multi Organ Transplant Unit (Brahmania), London Health Sciences Centre, Western University, London, Ont.

Mayur Brahmania (M)

University of Calgary Liver Unit (Congly), Division of Gastroenterology and Hepatology, Department of Medicine, University of Calgary, Calgary, Alta.; Division of Gastroenterology, Department of Medicine, and Multi Organ Transplant Unit (Brahmania), London Health Sciences Centre, Western University, London, Ont. mayur.brahmania@lhsc.on.ca.

Classifications MeSH