Reimbursement policies in Asia-Pacific for chronic Hepatitis B

Abstract: There is considerable variation in reimbursement policies in Asian countries and this is likely to have an impact on treatment practice for chronic hepatitis B. Consequently a survey of leading hepatologists was performed to evaluate such policies and their impact on management of chronic hepatitis B (CHB) in Asia. Methods: A questionnaire was sent to key hepatologists in Asia for information on prevalence of CHB, and whether there was a reimbursement policy, its nature, the coverage, funding source, duration, review strategy and is impact on APASL CHB guidelines. The results were analysed and described. Results: Physicians from 14/15 Asian countries responded. Prevalence of CHB varied from 1-20%. Almost all of the countries have reimbursement policies but eligibility varied from only limited group (eg, civil servants) to universal access. In most instances reimbursement was from central government (except China, Pakistan and Hong Kong). Reimbursement policies were usually made by Ministry of Health committees, who received input from medical professionals, although they may not have been aware of Asia Pacific Association for Study of Liver (APASL) guidelines. Policies were limited by available resources, funds and prioritization. Where there was a regular review this occurred between 1-5 years. The quantum of reimbursement varied from 50% (Singapore,Korea), 70-80% (Japan, China), to 100% (Taiwan, Indonesia, Thailand, Malaysia, Hong Kong, Vietnam). The criteria for treatment reimbursement was based on doctor’s opinion alone (Thailand, China, Malaysia, Pakistan, Singapore & Vietnam) or specific clinical/laboratory criteria (Australia, New Zealand, Taiwan, Indonesia, Hong Kong & Korea). In almost every country the first line reimbursed drug was lamivudine (except Hong Kong), but half of the countries also reimbursed entecavir. Somecountries (Taiwan, Indonesia & Korea) reimbursed only for limited duration of treatment. Monitoring tests for treatment response (LFT, FBC, AFP, HBeAg /Ab) were reimbursed in most countries, except for HBVDNA. Viral resistance was diagnosed by viral or biochemical breakthrough, and viral resistance testing was uncommon. The main rescue therapy was adefovir. Conclusions: Reimbursement policies varied considerably from country to country, but in many instances, APASL guidelines were generally able to be followed where reimbursement was available, with the exception of China, Hong Kong and Taiwan.