Listing of Direct Acting Antivirals (DAAs) for Chronic Hepatitis C on the Pharmaceutical Benefits Scheme (PBS)
Description
o From 1 March 2016 the Australian Government listed on the Pharmaceutical Benefits Scheme (PBS) Direct Acting Antivirals (DAAs) for the treatment and cure of chronic hepatitis C.<br />
o The listing of the new DAAs for the treatment of chronic hepatitis C on the PBS: <br />
supports the goal of the Fifth National Hepatitis C Strategy 2018-2022.<br />
supports the goal of eliminating hepatitis C as a public health threat by 2030.
o Listing of the DAAs on the PBS was designed to ensure the maximum number of Australians would have access to the curative treatments with no restriction placed on a person’s previous or current substance use, disease stage/severity, or whether they had previously been treated. <br />
o Listing of the DAAs on the PBS provides an opportunity to significantly reduce the burden of hepatitis C in Australia, as well as preventing new transmissions. This is consistent with the goals of the Fifth National Hepatitis C Strategy 2018-2022 and supports the SDG target of combating the hepatitis C epidemic.<br />
o Making the DAAs medications affordable for all Australians contributes to their uptake across communities that may otherwise not be able to access these medications. This has a positive impact across multiple SDGs by reducing inequalities, and supporting good health and wellbeing.<br />
o There are challenges in ensuring clinicians and eligible people that could benefit from the DAAs are aware of this biomedical advance. The Australian Government continues to work to overcome these challenges by partnering with national professional and community-based organisations to produce educational materials and undertake awareness raising activities.
o Australia’s Pharmaceutical Benefits Advisory Committee (PBAC) is an independent expert body appointed by the Australian Government. Members include doctors, health professionals, health economists and consumer representatives.
o Its primary role is to recommend medicines for listing on the PBS.
o When recommending a medicine for listing, the PBAC takes into account the clinical conditions for which the medicine was registered for use in Australia, the clinical efficacy, safety and cost-effectiveness (‘value for money’) compared with other medicines.
o To assist in the rollout of the DAAs on the PBS the Australian Government funded a number of activities to inform affected communities and health care professionals including specialist and primary care physicians along with pharmacists information on testing and the new treatment options. These activities included:
Web based resources along with face-to-face training activities to provide awareness raising and education on chronic hepatitis C, testing and treatment. General blood borne virus web based resources designed to reduce stigma and discrimination and build resilience were also developed to encourage uptake of treatment.
o The Australian Government is using a number of mechanisms to evaluate the rollout of the DAAs, including data on DAA use from the PBS and research to evaluate to assess the real work efficacy of the DAAs. Reports of this research can be found at: https://kirby.unsw.edu.au/report/real-world-efficacy-antiviral-therapy-…, https://kirby.unsw.edu.au/report/monitoring-hepatitis-c-treatment-uptak…
o Continued examination and analysis of surveillance data, PBS subscription data and medicine dispensing data to ensure that sufficient numbers of patients are accessing treatments to meet the targets in Australia’s Fifth National Hepatitis Strategy 2018-2022 and our commitments under the WHO’s Global Health Sector Strategy on Viral Hepatitis 2016-2021, with strategies in place if the numbers fall below certain levels.
o Information to assist consumers, prescribers and dispensers was published on the PBS website:
• http://www.pbs.gov.au/info/publication/factsheets/hep-c/hepc-factsheet-…
• http://www.pbs.gov.au/info/publication/factsheets/hep-c/hepc-factsheet-…
• http://www.pbs.gov.au/info/publication/factsheets/hep-c/hepc-factsheet-…
• http://www.pbs.gov.au/info/publication/factsheets/hep-c/hepc-factsheet-…
• http://www.pbs.gov.au/publication/factsheets/hep-c/files/hepc-infograph…
o An estimated 58,280 individuals initiated DAA treatment for chronic hepatitis C virus (HCV) infection through the PBS between March 2016 and March 2018, equating to approximately 26% of the people living with chronic HCV infection in Australia.
o It has been estimated that, of those individuals with known treatment outcomes, 96% were cured.
o There was an estimated 20% decline in deaths from hepatitis C-related liver failure and liver cancer in 2016–2017, compared with an estimated two-fold increase in the seven years before new treatments were available. There has also been a 42% decline in cirrhosis in the last 3 years.
o The proportion of respondents in Australia’s Needle and Syringe Program survey for 2017 who reported a lifetime history of HCV treatment was stable between 2012 and 2015 (10-13%) but increased to 29% in 2016 and 45% in 2017.
o One of the most important components of the hepatitis C response has been the ongoing and meaningful participation of people with hepatitis C, along with affected communities, in all aspects of the response. This is central to Australia’s partnership approach and is key to the success of the listing of the DAAs.
o Another key enabler is access to subsidised hepatitis C testing and treatment for all Australians.
o Continued engagement with consumers and health care professional organisations will maximise awareness of testing and treatment options for chronic hepatitis C, assist with treatment uptake and to help reduce stigma and discrimination.
o Australia’s coordinated approach health promotion and harm minimisation activities such as Opioid Substitution Therapy and Needle and Syringe Programs also help to minimise the risks of hepatitis C infection and reinfection.
o The uptake of DAAs is monitored to ensure the long term benefits of the subsidy are maintained.
In 2016, Australia became one of the first countries in the world to subsidise DAAs for the entire population of hepatitis C sufferers, no matter what their condition, how it was contracted and whether they had previously been treated. Prior to the listing of DAAs on the PBS, the estimated number of deaths in people living with chronic hepatitis C were increasing with each year. Since the listing, the number of deaths attributed to hepatitis C have been declining.<br />
<br />
Prior to DAAs being listed on the PBS, only specialist physicians were able to prescribe hepatitis C medications. To maximise access to the new treatments, the Australian Government expanded those able to prescribe hepatitis medications to include specialists, primary health care physicians and nurse practitioners.<br />
<br />
Overall, the Australian Government has successfully coordinated a reduction in rates of hepatitis C, as well as a reduction in hepatitis C morbidity and mortality, in the general population through:<br />
- listing DAAs on the PBS; <br />
- increased access to medications by increasing who is able to prescribe hepatitis C medications, <br />
- funding organisations to develop and implement general public and health professional educational awareness programs; and <br />
- continued funding of established harm minimisation activities, such as needle and syringe programs.
PBS listing of the DAAs
Pharmaceutical Benefits Advisory Committee (PBAC)
Specific websites developed to support the listing on the PBS of the DAAs
o http://testcurelive.com.au/
Other activity related resources can be found on the organisations websites:
o http://aivl.org.au/
o https://www.ashm.org.au/
o https://www.hepatitisaustralia.com/
o http://loveyourliver.com.au/
Activities aimed at reducing stigma and discrimination and building resilience:
o http://removingbarriers.ashm.org.au/
Other sources of related information can be found at:
o http://www.hepcguidelines.org.au/
Deliverables & Timeline
Resources mobilized
Partnership Progress
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Feedback
Action Network
Share
Timeline
Entity
SDGs
Region
- Asia and Pacific
Website/More information
Countries
Contact Information
Rebecca Newton, Dr