Impact of reimbursement program on liver‐related mortality in patients with chronic hepatitis B in Beijing, China

Abstract

Objective: Since July 1, 2011 antiviral therapy for hepatitis B virus infection has been listed as a reimbursable expense for medical insurance in Beijing. This study aimed to assess the impact of this program on liver-related death for patients with chronic hepatitis B (CHB).Methods: Profiles of patients with CHB discharged between January 2008 and December 2015 were retrieved from the Beijing hospital discharge database. Liverrelated deaths in these patients occurring between January 2008 and December 2017 were retrieved by linking them to the death certification database. Liver-related mortality (number of deaths divided by the observed person-years) before and after this program was launched was calculated and compared. A Poisson regression was performed to assess the strength of association (risk ratio [RR]) between the reimbursement program and liver-related mortality.Results: Information on 35 943 discharged patients (17 114 patients with noncirrhotic and 18 829 with compensated cirrhotic CHB) was retrieved. Altogether 3 832 liver-related deaths during the 190 695 person-years were observed. After the reimbursement program was launched, liver-related mortality per 100 person-years dropped from 0.38% to 0.16% for patients with non-cirrhotic CHB, and from 4.03% to 3.39% for those with compensated cirrhosis. The program was associated with a lower risk of developing liver-related death for patients with non-cirrhotic CHB (RR 0.40, 95% confidence interval [CI] 0.30-0.52) and those with compensated cirrhosis (RR 0.84, 95% CI 0.78-0.89).Conclusion: Coverage of antiviral therapy by basic medical insurance reduced the risk of developing liver-related death for patients with non-cirrhotic and with compensated cirrhotic CHB. K E Y W O R D Schronic hepatitis B, liver-related death, insurance health reimbursement *These two authors contributed equally to this work.

Changing clinical care cascade of patients with chronic hepatitis B in Beijing, China

“…The major contributor for this overall increase might be the progress by adopting a comprehensive strategy to increase awareness of CHB and affordability of antiviral therapy in Beijing as well as whole China. Specifically, the antiviral agents for HBV have included in the reimbursement list of Basic Medical Care Insurance in Beijing since July 1, 2011, thereby leading to a rapid increase around year 2011 5 , 19 .…”

“…Furthermore, the proportion of first-line therapy recommended by the international guidelines–entecavir and tenofovir had increased to 78•05% of the total antiviral agents in 2018. This improvement was mainly due to massive price reduction of antiviral agents and their inclusion to the reimbursement list 5 , 19 .…”

“…An interesting finding was that the proportion of hospital visits for HBV ≥4 times per year increased from 47 • 07% to 65 • 31%, whereas the proportion of hospitalization for CHB and its complications decreased from 50 • 57% in 2010 to 10 • 34% in 2018. This kind of changes of clinical care utility may reflect the fact that effective antiviral therapy reduced the disease progression and complication of CHB, therefore decreased the need for hospitalization 5 . Indeed, health economic study showed antiviral therapy for CHB is highly cost effective, all even cost saving 15 .…”

“…Up to 40% of patients with chronic hepatitis B (CHB) will develop liver-related complications and there are nearly 1 million HBV-related deaths each year 4 . Owing to these drastic clinical consequences of CHB, global efforts, including universal vaccination and high coverage of potent antiviral therapy for HBV, are continuously made aiming to reduce new infections and to improve the outcomes in the existing pool of CHB patients 5 . Up to now, the global HBsAg positive rate has significantly decreased to 3•5% over the past decades 6 .…”

Control of Chronic Hepatitis B in China: Perspective of Diagnosis and Treatment

“…From 2005 to 2019, 4 editions of "Guidelines on the Prevention and Treatment of Chronic Hepatitis B" were jointly issued by 2 sister branches of the Chinese Medical Association including the Chinese Society of Hepatology and Chinese Society of Infectious Diseases (3)(4)(5)(6). Sustained effort on continued medical education based in the clinical guidelines have raised the knowledge base of specialists and internists and improved the standard of care for CHB (7). Recently, the National Healthcare Secrurity Adminstration has conducted government negotiations to massively reduce the price of antiviral medicine.…”