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Uptake and predictors of direct-acting antiviral treatment for hepatitis C among people receiving opioid agonist therapy in Sweden and Norway: a drug utilization study from 2014 to 2017
Christer F. Aas
Helse Bergen HF
Corresponding Author
ORCiD: https://orcid.org/0000-0002-6469-9354
License:
This work is licensed under a CC BY 4.0 License. Read Full License
View the published version at Substance Abuse Treatment, Prevention, and Policy.
Background: Treatment with direct-acting antiviral agents (DAAs) offers an opportunity to eliminate hepatitis C virus (HCV) endemic among people who inject drugs (PWID) and people enrolled in opioid agonist therapy (OAT) programs. The objective of this study was to estimate and to compare HCV treatment uptake after the introduction of DAAs among patients receiving OAT in Sweden and Norway. We also aimed to evaluate predictors of DAAs treatment among OAT patients in both countries.
Methods: This observational study was conducted with data from The Swedish Prescribed Drug Register and The Norwegian Prescription Database. We studied dispensed medications to calculate HCV treatment among OAT patients from 2014 to 2017 in Sweden and Norway. HCV prevalence was estimated from primary and secondary sources. Dispensations of medicines from different therapeutic areas, which served as proxy for co-morbidities in 2017, were conditionally adjusted for age, gender, and OAT medications. Logistic regression was used to evaluate these parameters.
Results: In total 3,529 individuals were identified with dispensed OAT in the Swedish cohort and 7,739 individuals in the Norwegian cohort. HCV treatment was utilized by 407 persons in Sweden and 920 in Norway during the study period. Annual HCV and DAA treatment uptake increased in both countries. The estimated cumulative HCV treatment uptake at the end of 2017 was 31% in Norway and 28% in Sweden. DAA treatment was associated with increased age (aOR 1.8; 95% CI 1.0-3.2) and the dispensation of drugs used for diabetes (aOR 3.2; 95% CI 1.8-5.7) in Sweden. In Norway, lipid modifying agents and antibacterials were associated with decreased odds (aOR 0.4; 95%CI 0.2-0.9, aOR 0.8; 95%CI 0.6-1.0).
Conclusions: An increase in DAA treatment and HCV treatment uptake was observed among Swedish and Norwegian OAT patients whilst introducing new direct-acting antiviral treatment regimens. However, more than two thirds of the OAT population in Norway and Sweden were untreated at the beginning of 2018. A further scale-up is crucial in order to control and eliminate the HCV endemic among OAT patients.
Keywords
Hepatitis C, chronic hepatitis C, treatment uptake, direct-acting antivirals, opioid substitution treatment
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CURRENT STATUS: Published
Version 2
Posted 18 Jun, 2020
Published
On 30 Jun, 2020
No community comments so far
Editorial decision: Accept
On 22 Jun, 2020
Review #1 received
Received 19 Jun, 2020
Reviewer #1 agreed
On 17 Jun, 2020
Editor assigned
On 16 Jun, 2020
Reviewers invited
Invitations sent on 16 Jun, 2020
Submission checks complete
On 15 Jun, 2020
Editor invited
On 15 Jun, 2020
No comments provided
Reviewer #2 agreed
On 22 May, 2020
Review #2 received
Received 22 May, 2020
Editorial decision: Major Revision
On 22 May, 2020
Review #1 received
Received 07 Apr, 2020
Reviewer #1 agreed
On 03 Apr, 2020
Editor assigned
On 31 Mar, 2020
Reviewers invited
Invitations sent on 31 Mar, 2020
Submission checks complete
On 30 Mar, 2020
Editor invited
On 30 Mar, 2020
First submitted
On 26 Mar, 2020
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This preprint is under consideration at Substance Abuse Treatment, Prevention, and Policy. A preprint is a preliminary version of a manuscript that has not completed peer review at a journal. Research Square does not conduct peer review prior to posting preprints. The posting of a preprint on this server should not be interpreted as an endorsement of its validity or suitability for dissemination as established information or for guiding clinical practice.
Learn more about In Review
Research
Uptake and predictors of direct-acting antiviral treatment for hepatitis C among people receiving opioid agonist therapy in Sweden and Norway: a drug utilization study from 2014 to 2017
Christer F. Aas
Helse Bergen HF
Corresponding Author
ORCiD: https://orcid.org/0000-0002-6469-9354
Badges
Prescreen
This manuscript passed our Prescreen assessment
Complete author information
Appropriate declaration statements
Potential risks to human health
Prescreen
Peer Review Timeline
CURRENT STATUS: Published
Version 2
Posted 18 Jun, 2020
Published
On 30 Jun, 2020
No community comments so far
Editorial decision: Accept
On 22 Jun, 2020
Review #1 received
Received 19 Jun, 2020
Reviewer #1 agreed
On 17 Jun, 2020
Editor assigned
On 16 Jun, 2020
Reviewers invited
Invitations sent on 16 Jun, 2020
Submission checks complete
On 15 Jun, 2020
Editor invited
On 15 Jun, 2020
No comments provided
Reviewer #2 agreed
On 22 May, 2020
Review #2 received
Received 22 May, 2020
Editorial decision: Major Revision
On 22 May, 2020
Review #1 received
Received 07 Apr, 2020
Reviewer #1 agreed
On 03 Apr, 2020
Editor assigned
On 31 Mar, 2020
Reviewers invited
Invitations sent on 31 Mar, 2020
Submission checks complete
On 30 Mar, 2020
Editor invited
On 30 Mar, 2020
First submitted
On 26 Mar, 2020
Metrics
Comments: 0
PDF Downloads: ...
HTML Views: ...
License:
This work is licensed under a CC BY 4.0 License. Read Full License
View the published version at Substance Abuse Treatment, Prevention, and Policy.
Background: Treatment with direct-acting antiviral agents (DAAs) offers an opportunity to eliminate hepatitis C virus (HCV) endemic among people who inject drugs (PWID) and people enrolled in opioid agonist therapy (OAT) programs. The objective of this study was to estimate and to compare HCV treatment uptake after the introduction of DAAs among patients receiving OAT in Sweden and Norway. We also aimed to evaluate predictors of DAAs treatment among OAT patients in both countries.
Methods: This observational study was conducted with data from The Swedish Prescribed Drug Register and The Norwegian Prescription Database. We studied dispensed medications to calculate HCV treatment among OAT patients from 2014 to 2017 in Sweden and Norway. HCV prevalence was estimated from primary and secondary sources. Dispensations of medicines from different therapeutic areas, which served as proxy for co-morbidities in 2017, were conditionally adjusted for age, gender, and OAT medications. Logistic regression was used to evaluate these parameters.
Results: In total 3,529 individuals were identified with dispensed OAT in the Swedish cohort and 7,739 individuals in the Norwegian cohort. HCV treatment was utilized by 407 persons in Sweden and 920 in Norway during the study period. Annual HCV and DAA treatment uptake increased in both countries. The estimated cumulative HCV treatment uptake at the end of 2017 was 31% in Norway and 28% in Sweden. DAA treatment was associated with increased age (aOR 1.8; 95% CI 1.0-3.2) and the dispensation of drugs used for diabetes (aOR 3.2; 95% CI 1.8-5.7) in Sweden. In Norway, lipid modifying agents and antibacterials were associated with decreased odds (aOR 0.4; 95%CI 0.2-0.9, aOR 0.8; 95%CI 0.6-1.0).
Conclusions: An increase in DAA treatment and HCV treatment uptake was observed among Swedish and Norwegian OAT patients whilst introducing new direct-acting antiviral treatment regimens. However, more than two thirds of the OAT population in Norway and Sweden were untreated at the beginning of 2018. A further scale-up is crucial in order to control and eliminate the HCV endemic among OAT patients.
Figure 1