Retrospective Cohort Study
Copyright ©The Author(s) 2015. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Aug 28, 2015; 21(32): 9588-9597
Published online Aug 28, 2015. doi: 10.3748/wjg.v21.i32.9588
Impact of partial reimbursement on hepatitis B antiviral utilization and adherence
Qian Qiu, Xiao-Wan Duan, Yan Li, Li-Kun Yang, Yu Chen, Hui Li, Zhong-Ping Duan, Li Wang
Qian Qiu, Hui Li, Li Wang, Department of Epidemiology and Biostatistics, Institute of Basic Medical Sciences, Chinese Academy of Medical Sciences, School of Basic Medicine Peking Union Medical College, Beijing 100005, China
Xiao-Wan Duan, Yan Li, Li-Kun Yang, Yu Chen, Zhong-Ping Duan, Liver Center, Beijing You’an Hospital of Capital Medical University, Beijing 100069, China
Author contributions: Qiu Q and Duan XW contributed equally to this work; Wang L, Duan ZP and Li H designed the study; Qiu Q completed the data analysis and drafted the manuscript; Duan XW conducted the questionnaire survey; Li Y, Yang LK and Chen Y retrieved the electronic data; all authors reviewed the manuscript.
Supported by Foundation of Ministry of Science and Technology of China, No. 2012ZX10004904 and No. 2013ZX10002002006002; Bristol-Myers Squibb Company, No. AI463-961; and Innovative Foundation of Beijing Union Medical College.
Institutional review board statement: The study protocol was approved by the Ethical Review Committee of Beijing You’an Hospital of Capital Medical University and Institute of Basic Medical Sciences Chinese Academy of Medical Sciences.
Informed consent statement: Given that the study poses no more than the minimal risk, and it would not be practicable to contact all the 30451 CHB patients in the two cohorts, a waiver of the informed consent was allowed by the Ethical Review Committee for the first part of study, involving secondary analysis of data of the two cohorts for a total of 30451 CHB patients. But for the validation study part, written or oral informed consent was obtained from the participants dependent on questionnaire survey by face-to-face interview or telephone interview. Deidentification was done to assure confidentiality of the study data for the two parts.
Conflict-of-interest statement: None declared.
Data sharing statement: Technical appendix and output files of the statistical analysis available from the corresponding author at liwang@ibms.pumc.edu.cn.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Li Wang, PhD, Professor, Department of Epidemiology and Biostatistics, Institute of Basic Medical Sciences, Chinese Academy of Medical Sciences, School of Basic Medicine Peking Union Medical College, 5 Dong Dan San Tiao, Beijing 100005, China. liwang@ibms.pumc.edu.cn
Telephone: +86-10-65288170 Fax: +86-10-69156971
Received: March 12, 2015
Peer-review started: March 14, 2015
First decision: April 13, 2015
Revised: April 28, 2015
Accepted: June 15, 2015
Article in press: June 16, 2015
Published online: August 28, 2015
Processing time: 168 Days and 21.6 Hours
Abstract

AIM: To determine the impact of partial reimbursement for antivirals on antiviral utilization and adherence for chronic hepatitis B patients.

METHODS: This was a retrospective cohort study. Two separate cohorts were enrolled, including 14163 and 16288 chronic hepatitis B outpatients, respectively. These patients were referred to Beijing You’an Hospital before and after the new partial reimbursement for antivirals, which was implemented on July 1, 2011. Demographic characteristics (including medical insurance status), routine biochemical, virological and serology laboratory test results, and antiviral agents’ prescription information were collected from an electronic database. Patients were also defined as new and existing patients according to treatment history. Antiviral utilization, medication possession ratio and persistence rate were calculated and compared among the patients with different characteristics. A questionnaire survey was conducted among 212 randomly sampled outpatients from the same hospital to confirm the validity of the electronic database. Propensity score matching was used to adjust the distribution of patient’s characteristics which may influence the antiviral utilization. χ2 test or ANOVA was adopted and multivariate logistic regression was used to determine the factors associated with antiviral utilization and good adherence.

RESULTS: A total of 13364 outpatients from each cohort were enrolled after the propensity score matching. The antiviral utilization rate for the insured patients increased from 57.4% to 75.9% (P < 0.0001) after the reimbursement, and the rate among those who paid out-of-pocket increased from 54.9% to 56.7% (P = 0.028). Approximately 71% of the patients had a medication possession ratio of more than 80% in each cohort before reimbursement. This increased to 79.2% and 73.1% for insured patients and those who paid out-of-pocket, respectively (P < 0.0001). Insured patients and those who paid out-of-pocket had the similar persistence rates before reimbursement. But after reimbursement, insured patients had higher persistence rates than those who paid out-of-pocket at 6 (86.5% vs 81.5%, P < 0.0001), 9 (79.7% vs 69.9%, P < 0.0001), 12 (73.4% vs 61.9%, P < 0.0001), and 15 mo (66.6% vs 53.1%, P < 0.0001). The reimbursement could significantly improve adherence for the insured patients than those who paid out-of-pocket even after adjusting other covariates, with an interaction odds ratio of 1.422 (95%CI: 1.220-1.657, P < 0.0001). The questionnaire survey supported the validity of the electronic database.

CONCLUSION: The reimbursement policy shows a positive impact on antiviral utilization as well as adherence for insured chronic hepatitis B patients.

Keywords: Antiviral therapy; Adherence; Chronic hepatitis B; Compliance; Reimbursement

Core tip: High adherence is the key to ensuring the effectiveness of antiviral therapy and adherence can be influenced by cost and affordability which can be strongly influenced by reimbursement scheme. This study uniquely analyzed the impact of medication reimbursement on hepatitis B antiviral usage as well as treatment adherence in Beijing, China, where chronic hepatitis B infection is endemic. The results showed a positive impact of partial reimbursement on antiviral utilization as well as adherence for insured chronic hepatitis B patients. The results of this study could address a more global overall question rather than something at the patient level.