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Hepatitis C Treatment Uptake in WA

Initiations of New Treatment for Chronic Hepatitis C, October 2016 to March 2017

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, Alex Xiao and Peter Somerford (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

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

Telephone: (08) 9388 4999

Facsimile: (08) 9388 4877

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 18

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 (October 2016 to March 2017), and compares these trends to those found in the previous reporting period (March 2016 to September 2016).

A total of 2,872 residents, representing 14% 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 + ledipasvir and sofosbuvir + daclatasvir were the two most commonly prescribed DAA treatment regimens.

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 a 76% 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 from 1 October 2016 to 31 March 2017 by patient demographics, regimen, dispensing and prescriber characteristics, and to compare trends from this period to those found in the baseline report period from 1 March to 30 September 2016.

A total of 2,872 residents, representing 14% 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 previous reporting period to 56% 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, Midwest and South West regions and only initiation rates in the Pilbara region were significantly lower than the rate for the state as a whole.

The most commonly prescribed DAA treatment regimen was sofosbuvir + ledipasvir followed by sofosbuvir + daclatasvir. The proportion of residents who were dispensed DAA treatment through the PBS General Schedule (‘Section 85’) and from community pharmacies increased from the previous reporting period to the current reporting period. In the current reporting period, of the residents who were dispensed treatment, the majority in the Kimberley region received it under the PBS S100 HSD Public Program, whereas in the South West region the majority received it under the PBS General Schedule. Only the Midwest region had an increase in the proportion of residents who were dispensed treatment through the PBS S100 HSD Public Program from the previous reporting period to the current reporting period.

While approximately equal proportions of WA residents in the previous 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 previous reporting period, the majority of residents in the Great Southern, Midwest, South West and Kimberley regions were prescribed treatment by a specialist. In the current reporting period, only residents in the Great Southern and South West regions were predominately prescribed treatment by a specialist. There was a 76% increase in the number of unique prescribers for DAA treatment in WA from the previous reporting period to the current reporting period. The majority of prescribers were GPs, and from the previous 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 highest proportionate patient caseload among prescribing GPs was reported in the Wheatbelt region, where 11% had treated ten or more patients. The highest proportionate patient caseload among prescribing specialists was reported in the Midwest region, where 100% had treated ten or more patients.

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AbbreviationsABS Australian Bureau of Statistics

ASR Age standardised rate expressed per 100,000 population

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.

A previous baseline report described the number of people in Western Australia (WA) who initiated DAA treatment for chronic HCV from 1 March to 30 September 2016 by patient demographics, regimen, dispensing and prescriber characteristics. The aim of this second report is to describe the number of people in WA who initiated DAA treatment for chronic HCV from 1 October 2016 to 31 March 2017, and to compare trends from this period to those found in the baseline report.

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 October 2016 to 31 March 2017. 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.

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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 standardisation was utilised to control for differences in the size and age structure of various populations. Age standardised rates (ASRs) 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. ASRs 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 ASRs for those two regions. If the error bars for the two regions do overlap, there is no statistically significant difference in ASRs for the two regions. The ASRs for 2015 and 2016 can be compared in the similar manner as regional comparisons.

ResultsDAA treatment initiations by patient demographicsIn 2015, an estimated 20,549 WA residents were living with chronic HCV infection2. In the previous reporting period, from March 2016 to September 2016, a total of 1,827 residents initiated DAA treatment. In the current reporting period, from October 2016 to March 2017, an additional 1,045 residents initiated DAA treatment. Altogether, a total of 2,872 residents, representing 14% of residents living with chronic HCV in WA, have initiated the new DAA treatment since it was introduced in March 2016. 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).

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Figure 1. Number of WA residents initiating DAA treatment by month, March 2016 to March 2017

276

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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 (Table 1 and Table 2).

Table 1. Number, proportion and rate of WA residents initiating DAA treatment by sex, March 2016 to September 2016 and October 2016 to March 2017

Number % Total Rate (95% CI) Number % Total Rate (95% CI)

Male 1,236 67.7% 222.3 (215.3-229.3) 684 65.5% 125.24 (119.9-130.5)Female 591 32.3% 108.9 (103.9-113.9) 361 34.6% 68.63 (64.6-72.6)

Total 1,827 100.0% 130.9 (127.0-134.8) 1,045 100.0% 83.02 (79.9-86.1)

Age group (years)

Mar 16 - Sep 16 Oct 16 - Mar 17

Note: Rate = Annualised age standardised rate per 100,000 population. The rates for the Totals are annualised crude rates. 95% CI = lower and upper confidence limits

8

Table 2. Number, proportion and rate of WA residents initiating DAA treatment by age group, March 2016 to September 2016 and October 2016 to March 2017

Number % Total Rate Number % Total Rate

<20 0 0.0% 0.0 4 0.4% 4.5

20-29 71 3.9% 32.6 63 6.0% 29.130-39 259 14.2% 137.8 222 21.2% 115.5

40-49 352 19.3% 196.9 295 28.2% 164.050-59 735 40.2% 186.1 308 29.5% 80.0≥60 410 22.4% 166.0 153 14.6% 61.0

Total 1,827 100.0% 128.7 1,045 100.0% 79.1

Age group (years)

Mar 16 - Sep 16 Oct 16 - Mar 17

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

The proportion of WA residents initiating treatment who were aged less than 50 years increased from 37% in the previous reporting period to 56% in the current reporting period (Table 2 and Figure 2).

Figure 2. Proportion of WA residents initiating DAA treatment by age group and month, March 2016 to March 2017

4% 3% 6% 2%7% 4% 1% 4%

8% 6% 5% 8% 5%

9% 10%11% 21% 13% 17% 19%

21%

26%

20% 22% 15% 23%15% 16%

14%

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32%

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31%40%

44%45%

38% 34%39%

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32%27% 24%

20% 21%15% 17% 14% 16% 17%

13%17%

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Year and Month

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

Note: The age groups <20 years and 20-29 years were merged due to small numbers.

In both reporting periods, approximately equal proportions of residents were categorised as Concession and General patients (Table 3).

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Table 3. Number of WA residents initiating DAA treatment by beneficiary status and age group, March 2016 to September 2016 and October 2016 to March 2017

<30 30-39 40-49 50-59 ≥60 Number %

Concession 31 141 195 302 218 887 49%General 40 118 157 433 190 938 51%

Total 71 259 352 735 408 1,825 100%

Beneficiary status

Mar 16 - Sep 16Age group (years) Total

<30 30-39 40-49 50-59 ≥60 Number %

Concession 30 135 179 159 85 588 56%General 37 87 116 148 68 456 44%

Total 67 222 295 308 153 1,045 100%

Beneficiary status

Oct 16 - Mar 17Age group (years) Total

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 2016 to September 2016 period and one person in the October 2016 to March 2017 period were Repatriation PBS patients, and these have been excluded from this table. The age groups <20 years and 20-29 years were merged due to small numbers.

In the previous 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 Kimberley region due to low numbers, and the highest initiation rates were among residents in the Great Southern, Midwest and South West regions (Figure 3 and Figure 4).

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Figure 3. 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

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Note: Rate = Annualised age standardised rate per 100,000 population.

Figure 4. Number and rate of WA residents initiating DAA treatment by health region of residence, October 2016 to March 2017

314242 224

22 10 40 20 38104

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Note: Rate = Annualised age standardised rate per 100,000 population. Rate could not be calculated for the Kimberley region due to low numbers.

11

In the previous reporting period, only initiation rates in the Goldfields and Pilbara regions were significantly lower than the rate for the state as a whole. In the current reporting period, only initiation rates in the Pilbara region were significantly lower than the rate for the state as a whole (Figure 3, Figure 4 and Figure 5). The Goldfields and Pilbara were the only regions in which the initiation rate did not decrease significantly from the previous reporting period to the current reporting period (Figure 5).

Figure 5. Rate of WA residents initiating DAA treatment by health region of residence, March 2016 to September 2016 and October 2016 to March 2017

201.

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Note: Rate = Annualised age standardised rate per 100,000 population. Rate could not be calculated for the Kimberley region in the October 2016 to March 2017 reporting period due to low numbers.

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=0.005; October 2016 to March 2017: r=0.81, n=10, p=0.005) (Figure 6 and Figure 7).

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

East Metro, 201.2, 59.5

North Metro, 154.3, 34.9

South Metro, 175.6, 57.0

Goldfields, 99.6, 59.3

Kimberley, 281.8, 72.7

Midwest, 289.8, 61.0

Pilbara, 96.4, 39.4

Great Southern, 316.1, 66.8

South West, 216.4, 52.5

Wheatbelt, 162.8, 39.2

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Notification rate per 100,000 population

Note: Rate = Annualised age standardised rate per 100,000 population. Notification rate = Average age standardised notification rate per 100,000 population from 2013 to 2016.

Figure 7. Rate of WA residents initiating DAA treatment by rate of hepatitis C notifications and health region of residence, October 2016 to March 2017

East Metro, 53.4, 113.5

North Metro, 24.7, 79.97South Metro, 48.4, 86.2

Goldfields, 48.3, 85.06

Midwest, 61.3, 142.73

Pilbara, 30.1, 61.55

Great Southern, 84.8, 165.54

South West, 42.7, 139.6

Wheatbelt, 36.2, 93.3

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DAA treatment initiations by regimen and dispensing characteristicsSofosbuvir + ledipasvir and sofosbuvir + daclatasvir were the two most commonly prescribed DAA treatment regimens in WA (Figure 8 and Figure 9).

Figure 8. Proportion of WA residents initiating DAA treatment by regimen, March 2016 to September 2016

55%37%

3%2% 2%

1%

Sofosbuvir + ledipasvir

Sofosbuvir + daclatasvir

Sofosbuvir + ribavirin

Paritaprevir-ritonavir + ombitasvir +dasabuvirOther

Sofosbuvir + daclatasvir + ribavirin

Figure 9. Proportion of WA residents initiating DAA treatment by regimen, October 2016 to March 2017

49%

40%

3%

2% 2% 1%3%

Sofosbuvir + ledipasvir

Sofosbuvir + daclatasvir

Sofosbuvir + ribavirin

Paritaprevir-ritonavir + ombitasvir +dasabuvirOther

Sofosbuvir + daclatasvir + ribavirin

Elbasvir-grazoprevir

14

These treatment regimens were available through the PBS General Schedule (‘Section 85’) and the PBS Section 100 (S100) Highly Specialised Drugs (HSD) Program to enable dispensing through community pharmacies as well as public hospital and private hospital pharmacies.

The proportion of residents who were dispensed DAA treatment through the PBS General Schedule (‘Section 85’) and from community pharmacies increased from the previous reporting period to the current reporting period (Table 4, Figure 10 and Table 5).

Table 4. Number and proportion of WA residents initiating DAA treatment by pharmacy type, March 2016 to September 2016 and October 2016 to March 2017

Number % Total Number % Total

Community 884 48.4% 722 69.1%Public hospital 939 51.4% 322 30.8%Others 4 0.2% 1 0.1%

Total 1,827 100.0% 1,045 100.0%

Oct 16 - Mar 17Pharmacy type

Mar 16 - Sep 16

Note: Others include private hospitals and friendly societies.

Figure 10. Proportion of WA residents initiating DAA treatment by pharmacy type and month, March 2016 to March 2017

49% 49%45% 42% 40%

48%

68%63%

59%

76% 75% 76%70%

51% 50%55% 57% 59%

52%

32%37%

41%

24% 25% 24%30%

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Community Pharmacy Public Hospital Other

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Table 5. Number and proportion of WA residents initiating DAA treatment by program code, March 2016 to September 2016 and October 2016 to March 2017


General Schedule (s85) 890 48.7% 746 71.4%s100 HSD Public 920 50.4% 289 27.7%s100 HSD Private 17 0.9% 10 1.0%

Total 1,827 100.0% 1,045 100.0%

Program codeMar 16 - Sep 16 Oct 16 - Mar 17

In both reporting periods, of the residents who were dispensed treatment, the majority in the Kimberley region received it under the PBS S100 HSD Public Program, whereas in the South West region, the majority received it under the PBS General Schedule. Only the Midwest region had an increase in the proportion of residents who were dispensed treatment through the PBS S100 HSD Public Program from the previous reporting period to the current reporting period (Figure 11 and Figure 12).

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Figure 11. Proportion of WA residents initiating DAA treatment by health region of residence and program code, March to September 2016

46% 44% 45%54%

12%

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36%

76% 73%

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53% 56% 55%46%

88%

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General Schedule (s85) s100 HSD Public

Note: There were 17 WA residents who were dispensed DAA treatment through the s100 HSD Private code and these have been excluded from this graph.

Figure 12. Proportion of WA residents initiating DAA treatment by health region of residence and program code, October 2016 to March 2017

66% 64%

84%

55%

20%

63%70% 74%

91%

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32% 36%

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General Schedule (s85) s100 HSD Public

Note: There were 10 WA residents who were dispensed DAA treatment through the s100 HSD Private code and these have been excluded from this graph.

17

DAA treatment initiations by prescriber characteristicsWhile approximately equal proportions of WA residents in the previous 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 (Table 6 and Figure 13).

Table 6. Number and proportion of WA residents initiating DAA treatment by prescriber type, March 2016 to September 2016 and October 2016 to March 2017


GP 930 50.9% 647 61.9%Specialist 896 49.1% 398 38.1%

Total 1,826 100.0% 1,045 100.0%

Prescriber typeMar 16 - Sep 16 Oct 16 - Mar 17

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 each reporting period, and these have been excluded from this table.

Figure 13. Proportion of WA residents initiating DAA treatment by prescriber type and month, March 2016 to March 2017

43% 43%

54% 56% 53% 54% 54%60% 58%

63% 66%62% 64%

57% 57%

46% 44% 47% 46% 46%40% 42%

38% 34%38% 36%

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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 each reporting period, and these have been excluded from this table.

In the previous reporting period, the majority of residents in the Great Southern, Midwest, South West and Kimberley regions were prescribed treatment by a specialist (Figure 14). In the current reporting period, only residents in the Great Southern and South West regions were predominately prescribed treatment by a specialist (Figure 15).

18

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

59% 55% 53%

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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 and this has been excluded from this figure.

Figure 15. Proportion of WA residents initiating DAA treatment by health region of residence and prescriber type, October 2016 to March 2017

66% 68% 70% 68%

50%

60%

75%

16%

37%

52%

34% 32% 30% 32%

50%

40%

25%

84%

63%

48%

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

EastMetro

NorthMetro

SouthMetro


SouthWest

Wheatbelt


Prop

ortio

n of

WA

resi

dent

s di

spen

sed

trea

tmen

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 and this has been excluded from this figure.

19

There was a 76% increase in the number of unique prescribers for DAA treatment in WA from the previous reporting period to the current reporting period (Table 7). The majority of prescribers were GPs, and from the previous reporting period to the current reporting period, the proportion of prescribers who were specialists decreased (Table 7).

Table 7. Number and proportion of prescribers of DAA treatment by prescriber type, March 2016 to September 2016 and October 2016 to March 2017


GP 132 65.7% 282 79.9%Specialist 69 34.3% 71 20.1%

Total 201 100.0% 353 100.0%

Prescriber typeMar 16 - Sep 16 Oct 16 - Mar 17

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 reporting periods were gastroenterologists, hepatologists or general medicine specialists (Figure 16 and Figure 17).

20

Figure 16. 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 17. Proportion of prescribers of DAA treatment by prescriber speciality, October 2016 to March 2017

80%

11%

4%3%

0%2%

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

21

While prescribers in both reporting periods most frequently treated only one patient, a higher proportion of specialists compared to GPs, treated ten or more patients (Table 8).

Table 8. Case load of prescribers of DAA treatment by prescriber type, March 2016 to September 2016 and October 2016 to March 2017

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 182 64.5% 76 27.0% 21 7.4% 282 100.0%Specialist 33 46.5% 18 25.4% 20 28.2% 71 100.0%

Total 215 60.9% 94 26.6% 41 11.6% 353 100.0%

Prescriber type

Oct 16 - Mar 17Case 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 previous reporting period, the highest proportionate patient caseload among prescribing GPs was reported in the Kimberley region, where 50% had treated ten or more patients. In the current reporting period, the highest proportionate patient caseload among prescribing GPs was reported in the Wheatbelt region, where only 11% had treated ten or more patients (Figure 18 and Figure 19).

22

Figure 18. 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 19. Proportion of GPs treating 1, 2 to 9 and 10 or more WA residents with DAA treatment by health region of residence, October 2016 to September 2017

59% 63%67%

88%

60%

100%

67%

50%

68%63%

30% 26%26%

13%

40%

0%

33%

50%

29%

25%

10% 11%7%

0% 0% 0% 0% 0% 4%13%

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

EastMetro

NorthMetro

SouthMetro


SouthWest

Wheatbelt


Prop

ortio

n of

GPs



23

In the previous reporting period, the highest proportionate patient caseload among prescribing specialists was reported in the Great Southern and Wheatbelt regions, where 100% and 50% respectively, had treated ten or more patients. In the current reporting period, the highest proportionate patient caseload among prescribing specialists was reported in the Midwest region, where 100% had treated ten or more patients (Figure 20 and Figure 21).

Figure 20. 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



24

Figure 21. Proportion of Specialists treating 1, 2 to 9 and 10 or more patients WA residents with DAA treatment by health region of residence, October 2016 to September 2017

48%

38%

67%

33%

0% 0%

100%

60%

20%

67%

19%

25%

22%

67%

100%

0%

0%

20%

60%

0%

33%38%

11%

0% 0%

100%

0%

20% 20%

33%

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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