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Hepatitis C Treatment Uptake in WA

Initiations of New Treatment for Chronic Hepatitis C, March 2016 to September 2018

health.wa.gov.au

AcknowledgementsWe would like to thank the Pharmaceutical Benefits Scheme for providing the treatment data; Nasir Wabe and Heather-Marie Schmidt (NSW Ministry of Health), Tania Gavidia, Peter Somerford, Alex Xiao, Laura Kirkland, Colleen Koh and Jeanette Koh (Epidemiology Branch, Department of Health, Western Australia) for their assistance in producing the data presented in this report.

Contributors/EditorsKellie Mitchell, Donna Mak, Lisa Bastian, Carolien Giele and Jude Bevan

Immunisation, Surveillance and Disease Control Program Communicable Disease Control Directorate Department of Health, Western Australia PO Box 8172 Perth Business Centre Western Australia 6849

Telephone: (08) 9222 0255

Facsimile: (08) 9222 0254

Web: ww2.health.wa.gov.au

DisclaimerEvery endeavour has been made to ensure that the information provided in this document was accurate at the time of writing. However, infectious disease testing and notifications data are continuously updated and subject to change. As no formal statistical testing has been conducted, some caution should be taken in interpreting differences and trends in this report.

Copyright to this material is vested in the State of Western Australia unless otherwise indicated. Apart from any fair dealing for the purposes of private study, research, criticism or review, as permitted under the provisions of the Copyright Act 1968, no part may be reproduced or re-used for any purposes whatsoever without written permission of the State of Western Australia.

Published by This publication has been produced by the Department of Health, Western Australia.

1

ContentsKey points 3Executive summary 4Abbreviations 5Introduction and aims 6Results 7

DAA treatment initiations by patient demographics 7DAA treatment initiations by regimen and dispensing characteristics 14DAA treatment initiations by prescriber characteristics 19

References 26

2

Key points On 1 March 2016, new direct acting antiviral (DAA) oral regimens were listed on

the Pharmaceutical Benefits Scheme (PBS) for the treatment of chronic hepatitis C virus infection (HCV).

This report describes the number of WA residents who initiated DAA treatment for chronic HCV in the current reporting period (April 2018 to September 2018), and compares these trends to those found in the first reporting period (March 2016 to September 2016).

A total of 5,599 residents, representing 27% of residents living with chronic HCV in WA, have initiated the new DAA treatment since it was introduced in March 2016.

The highest initiation rate was among males and those aged 40 to 49 years.

In most regions, high DAA treatment initiation rates were associated with historically high HCV notification rates.

Sofosbuvir + velpatasvir was the most commonly prescribed DAA treatment regimen, following its listing on the PBS in August 2017.

There was an increase in the proportion of residents prescribed DAA treatment by a GP.

There was an increase in the proportion of residents who were dispensed treatment through the PBS General Schedule (‘Section 85’) and from community pharmacies.

There was an 80% increase in the number of unique prescribers for DAA treatment in WA.

The majority of prescribers treated only one patient, but a higher proportion of specialists compared to GPs, treated ten or more patients.

3

Executive summaryOn 1 March 2016, new direct acting antiviral (DAA) oral regimens were listed on the Pharmaceutical Benefits Scheme (PBS) for the treatment of chronic hepatitis C infection (HCV). The aim of this report is to describe the number of people in Western Australia (WA) who initiated DAA treatment for chronic HCV in the current reporting period from 1 April 2018 to 30 September 2018 by patient demographics, regimen, dispensing and prescriber characteristics, and to compare trends from this period to those found in the first reporting period from 1 March to 30 September 2016.

A total of 5,599 residents, representing 27% of residents living with chronic HCV in WA, have initiated the new DAA treatment since it was introduced in March 2016. Based on the total population rather than the population living with chronic HCV, the highest initiation rate in both reporting periods was among males and those aged 40 to 49 years. The proportion of WA residents initiating treatment who were aged less than 50 years increased from 37% in the first reporting period to 68% in the current reporting period. In both reporting periods, approximately equal proportions of residents were categorised as Concession and General patients. In the current reporting period, the highest initiation rates were among residents in the Great Southern and Wheatbelt regions and only the initiation rate in the North Metropolitan region was significantly lower than the rate for the state as a whole.

The most commonly prescribed DAA treatment regimen in the current reporting period was sofosbuvir + velpatasvir, following its listing on the PBS in August 2017. The proportion of residents who were dispensed DAA treatment through the PBS General Schedule (‘Section 85’) and from community pharmacies increased from the first reporting period to the current reporting period. In the first reporting period, only residents in the Kimberley and Pilbara regions were predominately dispensed treatment through the Section 100 (S100) Highly Specialised Drugs (HSD) Program. In the current reporting period, only the Great Southern region had an increase in the proportion of residents who were dispensed treatment through the S100 HSD Public Program.

While approximately equal proportions of WA residents in the first reporting period were prescribed DAA treatment by a GP or a specialist, the majority of residents in the current reporting period were prescribed treatment by a GP. In the first reporting period, only residents in the Goldfields and Pilbara regions were predominately prescribed treatment by a GP. In the current reporting period, there were no regions in which the majority of residents were prescribed treatment by a specialist. There was an 80% increase in the number of unique prescribers for DAA treatment in WA from the first reporting period to the current reporting period. The majority of prescribers were GPs, and from the first reporting period to the current reporting period, the proportion of prescribers who were specialists decreased. While prescribers most frequently treated only one patient, a higher proportion of specialists compared to GPs, treated ten or more patients. In the current reporting period, the proportionate patient caseload among prescribing GPs only increased in the Great Southern region, and the proportionate patient caseload among prescribing specialists only increased in the Pilbara and South West regions.

4

AbbreviationsAAR Age-adjusted rate expressed per 100,000 population

ABS Australian Bureau of Statistics

DAA Direct acting antiviral

DoH Department of Health, Western Australia

DVA Department of Veterans’ Affairs

ERP Estimated residential population

GP General practitioner

HCV Hepatitis C virus

HSD Highly Specialised Drugs

PBS Pharmaceutical Benefits Scheme

r Correlation coefficient

S100 Section 100

SA2 Statistical Area Level 2

WA Western Australia

5

Introduction and aimsOn 1 March 2016, new direct acting antiviral (DAA) oral regimens were listed on the Pharmaceutical Benefits Scheme (PBS) for the treatment of chronic hepatitis C infection (HCV). In addition, GPs and other medical practitioners experienced in the treatment of HCV became eligible to independently prescribe DAA treatment for chronic HCV under the PBS without consulting an infectious diseases physician, hepatologist or gastroenterologist.

The aim of this report is to describe the number of people in Western Australia (WA) who initiated DAA treatment for chronic HCV from 1 March 2016 to 30 September 2018 by reporting period, patient demographics, regimen, dispensing and prescriber characteristics.

Methods

Pharmaceutical Benefits Scheme (PBS) dataThe Department of Health, WA (DoH) received a de-identified extract of PBS data on the number of prescriptions for HCV treatment supplied to WA residents from 1 March 2016 to 30 September 2018. The data were extracted by selected drugs used for treating HCV or by selected PBS item codes or indications, where necessary. The indication was identified from the Authority Code or Streamlined Authority Code where available. WA residents were identified from the patient postcode as recorded on the Medicare Enrolment file at the date of supply. The patient postcode to state mapping was updated based on Australia Post’s ranges for each state and territory.

The data were analysed using the following PBS variables: patient identification number confidentialised, patient date of birth, patient sex, patient postcode, patient category, pharmacy type, prescriber ID confidentialised, prescriber derived major speciality, date of prescribing, date of supply, PBS item code, drug name, program code, streamlined authority code and authority code. Data on the patient’s Aboriginality were not made available.

Regional boundaries and population estimatesWA is divided into ten health administrative regions: three in the Perth metropolitan area (East, North and South), four in the Northern and Remote area (Goldfields, Kimberley, Midwest and Pilbara) and three in the Southern area (Great Southern, South West and Wheatbelt).

Population estimates used as denominators in the analyses were based on the mid-year population provided by the Australian Bureau of Statistics (ABS). The ABS calculates estimated residential populations (ERPs) at the Statistical Area Level 2 (SA2). Based on these population estimates, the Epidemiology Branch of the DoH derived postcode level population estimates. These postcodes are then grouped to defined health region boundaries. The population of each health region are then based on the sum of each postcode within that health region1.

6

Interpreting the resultsIn this report, initiation of treatment is expressed as the number, proportion and rate of WA residents who initiated DAA treatment for chronic HCV. Age-adjusted rates (AARs) are calculated to take account of differences in age composition when rates for different populations are compared. Age-specific rates were based on the specified age groups and calculated by dividing the number of initiations by the population of the same sex and age group. As no reliable estimates of the number of WA residents living with chronic HCV infection in each health region were available, initiation rates are based on the total population rather than the population living with chronic HCV and are annualised to allow for comparison over time. AARs and age-specific rates are expressed per 100,000 population. The 2001 Australian standard resident population from the ABS was used as the reference population for standardisation.

Error bars were used to display the 95% confidence intervals around the rates for each region. If the error bars for the two regions to be compared do not overlap, there is a statistically significant difference in AARs for those two regions. If the error bars for the two regions do overlap, there is no statistically significant difference in AARs for the two regions. The AARs by year can be compared in the similar manner as regional comparisons.

Where applicable, the data are presented in six-monthly reporting periods: the first from March-September 2016, the second from October 2016-March 2017, the third from April-September 2017; the fourth from October 2017-March 2018, and the current reporting period from April-September 2018.

ResultsDAA treatment initiations by patient demographicsIn 2015, an estimated 20,549 WA residents were living with chronic HCV infection2. From March 2016 to September 2018, a total of 5,599 residents, representing 27% of residents living with chronic HCV in WA, initiated the new DAA treatment. The initial increase and subsequent decline in treatment uptake was consistent with a “warehouse” effect, with a large number of patients in specialist clinics awaiting DAA treatment access initiating treatment in the early months (Figure 1). While the trend in DAA initiations fluctuated by reporting period, there was an overall decrease from the first to the current reporting period (Figure 2).

7

Figure 1. Number of WA residents initiating DAA treatment by month, March 2016 to September 2018

276

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317

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Figure 2. Number and rate of WA residents initiating DAA treatment by reporting period, March 2016 to September 2018

1,827 1,045 1,084 890 753

130.9

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8

The majority of WA residents who initiated the new DAA treatment between March 2016 and September 2018 were male (68%). Based on the total population rather than the population living with chronic HCV, the highest initiation rates were also among males. There were different trends in the initiation rate among males and females over the reporting periods (Figure 3).

Figure 3. Rate of WA residents initiating DAA treatment by sex and reporting period, March 2016 to September 2018

222.3 125.2 144.5 115.9 104.9108.9 68.6 64.2 54.9 41.20

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Note: 95% CI = lower and upper confidence limits

Of the WA residents who initiated the new DAA treatment between March 2016 and September 2018, 31% were aged 50 to 59 years but the proportion who were aged less than 50 years increased from 37% in the first reporting period to 68% in the current reporting period (Figure 4).

Based on the total population rather than the population living with chronic HCV, the highest initiation rates were generally among those aged 40 to 49 years and the initiation rate among those aged less than 30 years notably increased over time (Table 1).

9

Figure 4. Proportion of WA residents initiating DAA treatment by age group and reporting period, March 2016 to September 2018

4% 6% 8%13% 12%

14%

21% 21%

23% 25%19%

28% 27%

27%30%

40%

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<30 yrs 30-39 yrs 40-49 yrs 50-59 yrs ≥60 yrs

Table 1. Number, proportion and rate of WA residents initiating DAA treatment by age group and reporting period, March 2016 to September 2018 and April 2018 to September 2018

Number % Total Rate Number % Total Rate

<30 71 3.9% 23.1 93 12.4% 36.030-39 259 14.2% 137.8 191 25.4% 96.9

40-49 354 19.3% 198.0 225 29.9% 128.650-59 736 40.2% 186.1 157 20.8% 97.4≥60 410 22.4% 166.0 87 11.6% 34.2

Total 1,830 100.0% 128.9 753 100.0% 72.0

Apr 18 - Sep 18Age group (years)

Mar 16 - Sep 16

Note: Rate = Annualised age-specific rate per 100,000 population. The rates for the Totals are annualised crude rates.

In each reporting period from March 2016 to September 2018, approximately equal proportions of residents were categorised as Concession and General patients (Figure 5).

10

Figure 5. Proportion of WA residents initiating DAA treatment by beneficiary status and reporting period, March 2016 to September 2018

49%56%

62%54% 57%

51%44%

38%46% 43%

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Concession General

Note: The level of subsidy under the PBS depends on the patient’s beneficiary status. Concessional status is for people who are eligible to receive government entitlements, including pensioners and low-income earners. Eligible veterans and their dependents holding a Department of Veteran’s Affairs (DVA) health card are also entitled to medicines and additional pharmaceutical items at concessional rates under the Repatriation PBS. All other individuals are considered general beneficiaries and have a higher co-payment threshold. Two people in the March-September 2016 period, one person in the October 2016-March 2017 period and three people in the April-September 2017 period were Repatriation PBS patients, and these have been excluded from this figure.

In the first reporting period, the highest initiation rates were among residents in the Great Southern, Midwest and Kimberley regions. In the current reporting period, the rate could not be reliably calculated for the Goldfields, Kimberley and Pilbara regions due to low numbers, and the highest initiation rates were among residents in the Great Southern and Wheatbelt regions (Figure 6 and Figure 7).

11

Figure 6. Number and rate of WA residents initiating DAA treatment by health region of residence, March 2016 to September 2016

511438 426

24 42 7825

72154

57

1,827

201.2

154.3

175.6

99.6

281.8289.8

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Figure 7. Number and rate of WA residents initiating DAA treatment by health region of residence, April 2018 to September 2018

265

118195

17 9 20 12 33 54 30

753

94.5

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Note: Rate could not be calculated for the Goldfields, Kimberley and Pilbara regions in the April-September 2018 period due to low numbers. 95% CI = lower and upper confidence limits.

12

In the first reporting period, the initiation rate in most regions was significantly higher than the rate for the state as a whole; the Goldfields and Pilbara were the only regions with a significantly lower initiation rate. In the current reporting period, the initiation rate in most regions was either comparable to or significantly higher than the rate for the state as a whole; the North metro was the only region with a significantly lower initiation rate. The Wheatbelt was the only region in which the initiation rate did not decrease significantly from the first to the current reporting periods (Figure 8).

Figure 8. Rate of WA residents initiating DAA treatment by health region of residence, March 2016 to September 2016 and April 2018 to September 2018

201.

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Mar 16 - Sep 16 Apr 18 - Sep 18

Note: Rate could not be calculated for the Goldfields, Kimberley and Pilbara regions in the April 2018 to September 2018 period due to low numbers. 95% CI = lower and upper confidence limits.

In both reporting periods, high DAA treatment initiation rates were associated with historically high HCV notification rates (March 2016 to September 2016: r=0.78, n=10, p=0.007; April 2018 to September 2018: r=0.82, n=7, p=0.025) (Figure 9).

13

Figure 9. Rate of WA residents initiating DAA treatment by rate of hepatitis C notifications and health region of residence, March 2016 to September 2016 and April 2018 to September 2018

East metro, 52.4, 201.2

North metro, 24.4, 154.3

South metro, 47.6, 175.6

Goldfields, 48.3, 99.6

Kimberley, 54.8, 281.8

Midwest, 60.8, 289.8

Pilbara, 29.1, 96.4

Great Southern, 85.3, 316.1

South West, 42.7, 216.4

Wheatbelt, 35.8, 162.8

East metro, 49.6, 94.5

North metro, 24.2, 41.2

South metro, 42.6, 78.1 Midwest, 74.6, 80.9

Great Southern, 85.9, 151.1

South West, 39.5, 75.4

Wheatbelt, 54.0, 111.2

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Mar 16 - Sep 16 Apr 18 - Sep 18

Note: Rate = Annualised age-adjusted rate per 100,000 population. March-September 2016 period notification rate = Average age-adjusted notification rate per 100,000 population from 2013 to 2015. April-September 2018 period notification rate = Average

age-adjusted notification rate per 100,000 population from 2016 to 2018. Rates could not be calculated for the Goldfields, Kimberley and Pilbara regions in the April-September 2018 period due to low numbers.

DAA treatment initiations by regimen and dispensing characteristicsIn the first reporting period, sofosbuvir + ledipasvir and sofosbuvir + daclatasvir were the two most commonly prescribed DAA treatment regimens in WA (Figure 10). Sofosbuvir + velpatasvir was the first pan-genotypic drug regimen to be listed on the PBS in August 2017, and in the current reporting period was the most commonly prescribed DAA treatment regimen in WA (Figure 11).

14

Figure 10. Proportion of WA residents initiating DAA treatment by regimen, March 2016 to September 2016

sofosbuvir + ledipasvir55%

sofosbuvir + daclatasvir

37%

3%2% 2%

1%

sofosbuvir + velpatasvir

sofosbuvir + ribavirin

paritaprevir-ritonavir + ombitasvir +dasabuvirother

sofosbuvir + daclatasvir + ribavirin

elbasvir + grazoprevir

glecaprevir + pibrentasvir

Figure 11. Proportion of WA residents initiating DAA treatment by regimen, April 2018 to September 2018

sofosbuvir + velpatasvir

57%sofosbuvir + ledipasvir18%

other7%

elbasvir + grazoprevir

8%

glecaprevir + pibrentasvir

10%

sofosbuvir + daclatasvir

sofosbuvir + ribavirin

paritaprevir-ritonavir + ombitasvir +dasabuvirsofosbuvir + daclatasvir + ribavirin

15

These treatment regimens were available through both the PBS General Schedule (‘S85’) and the Section 100 (S100) Highly Specialised Drugs (HSD) Program to enable dispensing through community pharmacies as well as public hospital and private hospital pharmacies.

While approximately equal proportions of WA residents were dispensed DAA treatment through the General Schedule and the S100 HSD Public Program in the first reporting period, the majority of residents in the current reporting period were dispensed treatment through the General Schedule (Figure 12). Similarly, while approximately equal proportions of residents were dispensed treatment from community and public hospital pharmacies in the first reporting period, the majority of residents in the current reporting period were dispensed treatment from community pharmacies (Figure 13).

Figure 12. Proportion of WA residents initiating DAA treatment by program code and reporting period, March 2016 to September 2018

49%

71%76%

65% 68%

50%

28%24%

34% 31%

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General Schedule (s85) s100 HSD Public s100 HSD Private

16

Figure 13. Proportion of WA residents initiating DAA treatment by pharmacy type and reporting period, March 2016 to March 2018

48%

69%75%

65% 67%

51%

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Community Public hospital Others

Note: Others include private hospitals and friendly societies.

In the first reporting period, only residents in the Kimberley and Pilbara regions were predominately dispensed treatment through the S100 HSD Public Program (Figure 14). In the current reporting period, only the Great Southern region had an increase in the proportion of residents who were dispensed treatment through the S100 HSD Public Program (Figure 15).

17

Figure 14. Proportion of WA residents initiating DAA treatment by health region of residence and program code, March 2016 to September 2016

46% 44% 45%54%

12%

68%

36%

76% 73%

44%

53% 56% 55%46%

88%

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General Schedule (s85) s100 HSD Public

Figure 15. Proportion of WA residents initiating DAA treatment by health region of residence and program code, April 2018 to September 2018

63% 65%71%

65% 67%

100%

75%

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37% 34%28%

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General Schedule (s85) s100 HSD Public

Figure 14 and Figure 15 note: there were 17 and five WA residents who were dispensed DAA treatment through the s100 HSD Private code in the March-September 2016 and April-September 2018 periods, respectively. These have been excluded from these figures.

18

DAA treatment initiations by prescriber characteristicsWhile approximately equal proportions of WA residents in the first reporting period were prescribed DAA treatment by a GP or a specialist, the majority of residents in the current reporting period were prescribed treatment by a GP (Figure 16).

Figure 16. Proportion of WA residents initiating DAA treatment by prescriber type and reporting period, March 2016 to September 2018

51%

62%69% 65%

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GP Specialist

Note: The prescriber type is based on the prescriber's registered specialties and Medicare services. The prescriber type was recorded as unknown for one resident in the March-September 2016 period and the October 2016 -March 2017 period; 10 residents in the April-September 2017 period; 12 residents in the October 2017-March 2018 period; three in the April-September 2018 period. These have been excluded from this figure.

In the first reporting period, only residents in the Goldfields and Pilbara regions were predominately prescribed treatment by a GP (Figure 17). In the current reporting period, there were no regions in which the majority of residents were prescribed treatment by a specialist (Figure 18).

19

Figure 17. Proportion of WA residents initiating DAA treatment by health region of residence and prescriber type, March to September 2016

59% 55% 53%

71%

36%29%

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15%

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41% 45% 47%

29%

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Figure 18. Proportion of WA residents initiating DAA treatment by health region of residence and prescriber type, April 2018 to September 2018

56%

69% 65%

88%

78%

60%

42%45%

54%60%

43%

31% 34%

12%

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t


GP Specialist

Note: The health region of the patient residence was used as provider type address was unknown at the time of reporting. The prescriber type is based on the prescriber's registered specialties and Medicare services. The prescriber type was recorded as unknown for one resident each in the March-September 2016 and April-September 2018 periods, and these have been excluded from these figures.

20

The number of unique prescribers for DAA treatment in WA increased by 80% from the first to the current reporting period. The majority of prescribers were GPs, and from the first to the current reporting period, the proportion of prescribers who were specialists decreased (Table 2).

Table 2. Number and proportion of prescribers of DAA treatment by prescriber type and reporting period, March 2016 to September 2018

Number % Total Number % Total Number % Total Number % Total Number % Total

GP 132 65.7% 282 79.9% 377 84.2% 330 81.1% 300 83.1%Specialist 69 34.3% 71 20.1% 71 15.8% 77 18.9% 61 16.9%

Total 201 100.0% 353 100.0% 448 100.0% 407 100.0% 361 100.0%

Apr 18 - Sep 18Prescriber type

Mar 16 - Sep 16 Oct 16 - Mar 17 Apr 17 - Sep 17 Oct 17 - Mar 18

Note: The prescriber type is based on the prescriber's registered specialties and Medicare services. As a result, a prescriber can appear in more than one category over time.

The majority of specialists in both the first and current reporting periods were gastroenterologists, hepatologists or general medicine specialists (Figure 19 and Figure 20).

21

Figure 19. Proportion of prescribers of DAA treatment by prescriber speciality, March 2016 to September 2016

65%

19%

9%

4%

2% 2%

General practitionersGasteroenterologists/hepatologistsGeneral medicine specialistsInfectious diseases physiciansPublic health medicine specialistsOther prescribers

Figure 20. Proportion of prescribers of DAA treatment by prescriber speciality, April 2018 to September 2018

83%

10%

3%

2% 0%2%

General practitionersGasteroenterologists/hepatologistsGeneral medicine specialistsInfectious diseases physiciansPublic health medicine specialistsOther prescribers

22

While prescribers most frequently treated only one patient, specialists tended to have a higher patient caseload compared to GPs. From the first to the current reporting period, there was a marked decrease in the proportion of prescribers who treated ten or more patients (Table 3).

Table 3. Caseload of prescribers of DAA treatment by prescriber type, March 2016 to September 2016 and April 2018 to September 2018

Number % Total Number % Total Number % Total Number % Total

GP 73 55.3% 37 28.0% 22 16.7% 132 100.0%Specialist 28 40.6% 18 26.1% 23 33.3% 69 100.0%

Total 101 50.2% 55 27.4% 45 22.4% 201 100.0%

Prescriber type

Mar 16 - Sep 16Case load

Total1 patient 2-9 patients ≥10 patients

Number % Total Number % Total Number % Total Number % Total

GP 212 70.7% 77 25.7% 11 3.7% 300 100.0%Specialist 27 44.3% 27 44.3% 7 11.5% 61 100.0%

Total 239 66.2% 104 28.8% 18 5.0% 361 100.0%

Prescriber type

Apr 18 - Sep 18Case load

Total1 patient 2-9 patients ≥10 patients

Note: The prescriber type is based on the prescriber's registered specialties and Medicare services. As a result, a prescriber can appear in more than one category over time.

In the first reporting period, the highest proportionate patient caseload among prescribing GPs was reported in the Kimberley region. In the current reporting period, the proportionate patient caseload among prescribing GPs only increased in the Great Southern region (Figure 21 and Figure 22).

In the first reporting period, the highest proportionate patient caseload among prescribing specialists was reported in the Great Southern and Wheatbelt regions. In the current reporting period, the proportionate patient caseload among prescribing specialists only increased in the Pilbara and South West regions (Figure 23 and Figure 24).

23

Figure 21. Proportion of GPs treating 1, 2 to 9 and 10 or more WA residents with DAA treatment by health region of residence, March 2016 to September 2016

51% 52%56%

50% 50%

80%75%

100%

46%

71%

31%

20%

28%

50%

0%

20%

0%

0%

54%

14%

18%

28%

16%

0%

50%

0%

25%

0% 0%

14%

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

EastMetro

NorthMetro

SouthMetro


SouthWest

Wheatbelt


Prop

ortio

n of

GPs


1 patient 2-9 patients 10+ patients

Figure 22. Proportion of GPs treating 1, 2 to 9 and 10 or more WA residents with DAA treatment by health region of residence, April 2018 to September 2018

57%

78%70% 69%

100%

81% 80% 78%83% 81%

36%

20%28%

23%

0%

19% 20%

11%

17% 19%

7%2% 2%

8%0% 0% 0%

11%

0% 0%

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

EastMetro

NorthMetro

SouthMetro


SouthWest

Wheatbelt


Prop

ortio

n of

GPs



24

Figure 23. Proportion of Specialists treating 1, 2 to 9 and 10 or more patients WA residents with DAA treatment by health region of residence, March 2016 to September 2016

58%

30% 29%

100%

33% 33%

50%

0%

50% 50%

16%

35%

29%

0%

33% 33%

50%

0%

50%

0%

26%35%

43%

0%

33% 33%

0%

100%

0%

50%

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

EastMetro

NorthMetro

SouthMetro


SouthWest

Wheatbelt


Prop

ortio

n of

spe

cial

ists



Figure 24. Proportion of Specialists treating 1, 2 to 9 and 10 or more patients WA residents with DAA treatment by health region of residence, April 2018 to September 2018

42%

27%

43%

100%

80%

0%

100%

50% 50%

53%

55%

50%

0%

20%

100%

0%

17%

0%

5%

18%

7%0% 0% 0% 0%

33%

50%

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

EastMetro

NorthMetro

SouthMetro


SouthWest

Wheatbelt


Prop

ortio

n of

spe

cial

ists



25

References1. Program Evaluation Unit, Department of Treasury WA (2016). Geographic

boundaries in Western Australia. A guide for analysts and data users. Perth: Department of Treasury WA

2. The Kirby Institute (2016). Hepatitis B and C in Australia annual surveillance report supplement 2016. NSW: The Kirby Institute, UNSW Australia

26

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