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Impact of public prescription drug coverage on newer hepatitis C medicines in British Columbia Ho, Harriet


Background: Sofosbuvir and ledipasvir-sofosbuvir are breakthrough direct-acting antiviral agents (DAAs) for the treatment of hepatitis C virus (HCV) infection. These drugs were very expensive at initial listing with a price of around $60,000 CAD. However, the cure rates and side effect profiles showed drastic improvements compared to interferon-based treatments. Given limited real-world data on adherence to DAAs, this study examined adherence to sofosbuvir and ledipasvir-sofosbuvir, and identified factors associated with adherence. It also examined the impact of public prescription drug coverage (PharmaCare) on adherence, treatment uptake, and expenditure. Methods: This study used data from the British Columbia Hepatitis Testers Cohort. Adherence was measured as proportion of days covered (PDC), calculated from prescription drug data. I used multivariable logistic regression to examine the impact of various factors on full adherence (PDC=100%). I also used interrupted time series analysis to examine the impact of PharmaCare coverage on adherence, treatment uptake, and public and private expenditure over time. Results: Of 3,730 treatments initiated, 2,760 were eligible for analysis; 786 were treated with sofosbuvir, 1,974 were treated with ledipasvir-sofosbuvir, and 14 were treated with both. Mean PDC across both drugs, sofosbuvir, and ledipasvir-sofosbuvir were 96.17%, 95.35%, and 96.50% respectively. In the multivariable logistic regression model, several factors were statistically significant. Major mental illness, longer treatment durations, moderate socioeconomic status, and being of white ethnicity were all associated with lower proportions of individuals with full adherence. Having PharmaCare coverage and being over the age of 60 were associated with higher proportions of individuals with full adherence. In the interrupted time series analysis, the availability of PharmaCare coverage for sofosbuvir and ledipasvir-sofosbuvir did not impact trends in adherence, but did increase treatment uptake of both drugs. Furthermore, public expenditure increased after the policy change, crowding out some of the private expenditure. Conclusion: Given the high cost of these drugs, the high adherence rates found are encouraging. Strategies to target those with major mental illness and longer treatment durations should be explored. Payers should also be prepared for increased treatment uptake and public expenditures following the availability of public coverage.

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