Messages from Japan policy for viral hepatitis

Abstract

In Japan, the estimated number of chronic HBV infections was 1.1-1.2 million and that of chronic HCV was 0.9-1.3 million in 2015. The mortality of hepatocellular carcinoma (HCC) had been increasing and hit a peak at around 2002, which subsequently started to decrease. Japan has a national action plan for addressing viral hepatitis called, "Basic Act on Hepatitis Measures", established in 2009. "Basic Guidelines for Promotion of Control Measures for Hepatitis" was issued in 2011 and was updated in 2016, comprising 9 principles in order to promote measures to prevent hepatitis B and C. According to these guidelines, national and local government share screening costs for testing HBV and HCV for those residents who are over 40 years old. Thus, out-of-pocket expenses from examinees are free of charge or reduced to a minimum. In addition, for patients with chronic hepatitis B or C being treated: drug prices of nucleotide analogues, interferon treatment or direct antiviral agents, and examination expenses should be covered by a special program for viral hepatitis. From December 2018, the special coverage program of medical expenses, shared by central and local government, has started for patients with HBV-or HCV-induced liver cancer and decompensated cirrhosis. However, in the cascade-of-care of viral hepatitis in Japan, significant gaps still remain in the diagnosis, treatment and transition to patients in need. Several advantages have prevailed in Japanese health care systems for patients with viral liver disease compared to those in other countries in the Western Pacific Region. Therefore, Japan should take a lead in helping the implementation of a practical hepatitis action plan for each country in need.

Effect of COVID‐19 on hepatitis B and C virus countermeasures: Hepatologist responses from nationwide survey in Japan

“…In Japan, since 1995–2000, HBV and HCV have been recognized as major health problems particularly among those born before the adoption of routine hepatitis B vaccination of infants and recipients of blood and blood products before routine screening of the blood supply 3 . As for the viral hepatitis countermeasure, several initiatives have been adopted by government such as free HBV and HCV testing and screening among people ≥40 years old and a medical expense subsidy system for antiviral treatment of HBV and HCV under the Basic Act on Hepatitis Measures (2010) 3–6 . In addition, the National Campaign Project for Hepatitis Measures (2013) for awareness and a routine three doses of hepatitis vaccine to all infants (2017) contributed to gradual decreases in the incidence and prevalence of HBV and HCV infections 7,8 .…”

“…3 As for the viral hepatitis countermeasure, several initiatives have been adopted by government such as free HBV and HCV testing and screening among people ≥40 years old and a medical expense subsidy system for antiviral treatment of HBV and HCV under the Basic Act on Hepatitis Measures (2010). [3][4][5][6] In addition, the National Campaign Project for Hepatitis Measures (2013) for awareness and a routine three doses of hepatitis vaccine to all infants (2017) contributed to gradual decreases in the incidence and prevalence of HBV and HCV infections. 7,8 Indeed, until 2020, Japan was moving in the right direction to achieve HBV and HCV elimination by 2030.…”

Real-World Epidemiology, Clinical and Economic Burden of Chronic Hepatitis B in Japan: A Retrospective Study Using JMDC Claims Database

“…Finally, because the definition of drug prescription is based on insurance data, patients who do not meet the criteria for Nas therapy, and who may be on non-reimbursed (out-of-pocket) treatment, are not captured, although this is assumed to be limited given the treatment guideline and duration of treatment (lifetime treatments). Furthermore, the treatment for individuals whose CHB progressed towards HCC or DC could be covered by a special subsidy program implemented from 2018 [ 18 ].…”

Integrated policy of medical expense subsidies and clinical registry for patients with liver cancer and decompensated cirrhosis in Japan

“…For example, hepatitis virus screening by local governments is provided free of charge, and individuals who require treatment for viral hepatitis can receive subsidies for medical expenses that include the cost of medication and testing costs based on their household's municipal tax revenue. 9,14,15 To encourage hepatitis virus testing, various initiatives including posting information on websites and in newsletters, and providing individual guidance and recommendations are undertaken by local governments. 16 These efforts have led to a growing number of people who undergo hepatitis B and C virus testing.…”