Impact of reimbursement program on liver-related mortality in patients with chronic hepatitis B in Beijing, China

J Dig Dis. 2019 Sep;20(9):467-475. doi: 10.1111/1751-2980.12794. Epub 2019 Jul 21.

Abstract

Objective: Since July 1, 2011 antiviral therapy for hepatitis B virus infection has been listed as a reimbursable expense for medical insurance in Beijing. This study aimed to assess the impact of this program on liver-related death for patients with chronic hepatitis B (CHB).

Methods: Profiles of patients with CHB discharged between January 2008 and December 2015 were retrieved from the Beijing hospital discharge database. Liver-related deaths in these patients occurring between January 2008 and December 2017 were retrieved by linking them to the death certification database. Liver-related mortality (number of deaths divided by the observed person-years) before and after this program was launched was calculated and compared. A Poisson regression was performed to assess the strength of association (risk ratio [RR]) between the reimbursement program and liver-related mortality.

Results: Information on 35 943 discharged patients (17 114 patients with non-cirrhotic and 18 829 with compensated cirrhotic CHB) was retrieved. Altogether 3 832 liver-related deaths during the 190 695 person-years were observed. After the reimbursement program was launched, liver-related mortality per 100 person-years dropped from 0.38% to 0.16% for patients with non-cirrhotic CHB, and from 4.03% to 3.39% for those with compensated cirrhosis. The program was associated with a lower risk of developing liver-related death for patients with non-cirrhotic CHB (RR 0.40, 95% confidence interval [CI] 0.30-0.52) and those with compensated cirrhosis (RR 0.84, 95% CI 0.78-0.89).

Conclusion: Coverage of antiviral therapy by basic medical insurance reduced the risk of developing liver-related death for patients with non-cirrhotic and with compensated cirrhotic CHB.

Keywords: chronic hepatitis B; insurance health reimbursement; liver-related death.

Publication types

  • Observational Study

MeSH terms

  • Adult
  • Age Distribution
  • Antiviral Agents / economics
  • Antiviral Agents / therapeutic use
  • Beijing / epidemiology
  • Databases, Factual
  • Death Certificates
  • Drug Costs / statistics & numerical data
  • Female
  • Hepatitis B, Chronic / complications
  • Hepatitis B, Chronic / drug therapy
  • Hepatitis B, Chronic / economics
  • Hepatitis B, Chronic / mortality*
  • Humans
  • Insurance, Health, Reimbursement / statistics & numerical data*
  • Liver Cirrhosis / economics
  • Liver Cirrhosis / mortality
  • Liver Cirrhosis / virology
  • Male
  • Medical Record Linkage
  • Middle Aged
  • Risk Factors
  • Sensitivity and Specificity
  • Sex Distribution

Substances

  • Antiviral Agents