(ASPOT20) Population-level utilization of direct-acting antiviral agents and trends in hepatitis C related hospitalizations

Background: Hepatitis C virus (HCV) represents the largest public health burden of any infectious disease. Fortunately, HCV is curable with direct-acting antivirals (DAAs). However, access to treatment was initially restricted around the world to individuals meeting specific thresholds of liver fibrosis and later expanded.

Objectives: To provide updated estimates of trends in DAA utilization, the associated costs of treatment, and HCV-related hospitalizations in Ontario, Canada.

Methods: We conducted a population-based ecologic analysis of the quarterly number of people dispensed a DAA, and the rate of HCV-related hospitalizations between April 1, 2015, and December 31, 2022. We used administrative healthcare data housed at ICES to identify all people eligible for public drug benefits who were dispensed at least one DAA over the study period and the total cost of claims reimbursed by the Ontario Public Drug Programs. We also identified all HCV-related hospitalizations for liver-related conditions reported as a rate per 10,000 Ontario population. All analyses were stratified by birth cohort (i.e., people born before and on/after January 1, 1976).

Results: Following their coverage by the publicly funded drug benefit program, the number of people dispensed a DAA increased more than two-fold from Q2 2015 (N=422) to Q4 2022 (N=938). The total costs associated with DAA treatment, increased in parallel from $14.5 to $34.4 million. This differed by birth cohort, with a 10.2% increase in DAAs dispensed (N=403 to 444) and a 23.4% increase in costs ($13.9 to $17.1 million) among people born pre-1976 compared to a 2500.0% increase in DAAs dispensed (N=19 to 494) and a 2872.5% increase in costs ($0.6 to $17.3 million) among people born during/after 1976. Over the same period, HCV-related hospitalizations decreased 56.7% (N=763 to 330; 0.55 to 0.22 per 10,000). Differences were observed by birth cohort with a 63.9% decrease among people born pre-1976 (N=656 to 237; 0.91 to 0.37 per 10,000), compared to a 13.1% decrease among people born during/after 1976 (N=107 to 93; 0.16 to 0.11 per 10,000).

Conclusions: In Ontario, HCV-related hospitalizations have declined in parallel with expanded access to DAAs among people with HCV. Differences observed among birth cohorts highlights the impact of these treatments in reducing healthcare system burden among people born pre-1976 and reinforces the need to make this group a priority for HCV screening.