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. 2021 May 21:9:667253.
doi: 10.3389/fpubh.2021.667253. eCollection 2021.

Increasing Number of Individuals Receiving Hepatitis B nucleos(t)ide Analogs Therapy in Germany, 2008-2019

Anna Maisa  1 , Christian Kollan  1 , Matthias An der Heiden  1 , Florian van Bömmel  2 , Markus Cornberg  3 , Stefan Mauss  4 , Heiner Wedemeyer  3 , Daniel Schmidt  1 , Sandra Dudareva  1
Affiliations

Increasing Number of Individuals Receiving Hepatitis B nucleos(t)ide Analogs Therapy in Germany, 2008-2019

Anna Maisa et al. Front Public Health. .

Erratum in

Abstract

Background: Germany is a low prevalence country for hepatitis B virus (HBV) infection with higher prevalence in vulnerable groups. The number of treated chronic hepatitis B (CHB) patients is unknown. We aimed to determine the number of CHB patients treated with nucleos(t)ide analogs (NUCs), the treatment costs within the statutory health insurance (SHI) in Germany and per patient per month. Methods: Data on pharmacy bills of NUCs to patients with SHI between 2008 and 2019 were purchased from Insight Health™ and described. Negative binomial regression was used for trend analysis. Results: Number of patients increased between 2008 and 2019 (4.9% per year) with little changes in treatment options. Overall prescription costs were increasing (6.7% per year on average) until the introduction of tenofovir and entecavir generics in 2017 after which costs decreased by 31% in 2019. Average therapy costs peaked at 498 Euro per patient per month in 2016 and decreased to 214 Euro in 2019. Prescriptions changed from 30 to 90 pills per pack over time. HBV therapy was prescribed to 97% by three medical specialist groups, mainly specialists in internal medicine (63%), followed by hospital-based outpatient clinics (20%) and general practitioners (15%). Contrary to guideline recommendation, adefovir was still prescribed after 2011 for 1-5% of patients albeit with decreasing tendency. Prescriptions per 100,000 inhabitants were highest in Berlin and Hamburg. Conclusion: Our data shows, that the number of treated CHB patients increased steadily, while NUC therapy costs decreased. We recommend continued testing and treatment for those eligible to prevent advanced liver disease and possibly decrease further transmission of HBV.

Keywords: hepatitis B; hepatitis elimination; nucleos(t)ide therapy; therapy costs; treatment gap; treatment guidelines.

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Conflict of interest statement

MC declares to having received payment or consultancy fees from Gilead Sciences, Janssen-Cilag, Spring Bank Pharmaceuticals, GlaxoSmithKline and Roche on the subject of hepatitis B. MC department or institution has received funding from Roche and Gilead Sciences for research projects as well as from Gilead Sciences and Janssen-Cilag for carrying out clinical studies. SM declares to having received payment or consultancy fees from Janssen-Cilag. FB declares to having received payment or consultancy fees from Gilead Sciences, Janssen-Cilag, Abbvie, Arbutus, Springbank and Roche and BMS; payment to cover cost of participation in a conference or educational event, travel or accommodation expenses related to the topic from Gilead Sciences, Janssen-Cilag and Roche; research funding from Gilead Sciences, Janssen-Cilag and Roche; and funding for carrying out clinical studies from Gilead Sciences. HW declares to having received payment for lectures or consultancy fees from Abbott, Abbvie, Altimmune, Biotest, BMS, BTG, Dicerna, Gilead, Janssen, Merck/MSD, MYR GmbH, Novartis, Roche and Siemens; research funding from Abbvie, Biotest, BMS, Gilead, Merck/MSD, Novartis and Roche; and funding for carrying out clinical studies from Abbvie, Altimmune, BMS, Gilead, Janssen, Merck/MSD, MYR GmbH, Novartis and Transgene. The remaining authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
Number of chronic hepatitis B patients treated per month by drug, 2008–2019. The black line shows the cost per patient per month in Euro.
Figure 2
Figure 2
Proportion of prescriptions issued per year by prescription size, 2008–2019. P30–30 pills per prescription; P60–60 pills per prescription; P90–90 pills per prescription.
Figure 3
Figure 3
Prescriptions per 100,000 population by Federal State, Germany, 2008–2019.
See this image and copyright information in PMC

References

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