An Investigation On The Access To Drugs Against Hepatitis B Virus In Comprehensive Hospitals,Yunnan Province(2018)

BackgroundHepatitis B virus(HBV)infection is a worldwide epidemic and a global public health problem.Chronic hepatitis B(CHB)is one of the common chronic infectious diseases in China,China is a moderately endemic area.Due to the impact of active replication of HBV on liver disease progression,active antiviral therapy is advocated clinically.From ordinary interferon(IFN)to tenofovir alafenamide(TAF),which is about to be marketed in China,The development of anti-HBV drugs has brought more options for the prevention and treatment of chronic HBV infection.Recently,the lancet reviewed the availability of medical care in 195 countries,including China.The study pointed out that China's overall ranking had been advanced by 2016,but the imbalance of regional development was significant.In order to understand the availability of anti-HBV drugs in China's basic hospitals in detail and better guide grassroots medical workers to carry out clinical practice,we conducted an investigation and study on the ownership rate and affordability of anti-HBV drugs in public hospitals in yunnan province.ObjectiveTo investigate the availability of anti-HBV drugs in public hospitals above county level in yunnan province and evaluate the potential impact of anti-HBV drug availability on anti-HBV treatment and prevention of mother-to-child transmission strategies.Methods1.The survey was conducted on public hospitals and 32 retail pharmacies in 16 cities of yunnan province.Questionnaire survey on the establishment of infection department of general hospital and the ownership rate of anti-HBV drugs and their drug costs,The distribution of anti-viral drugs classified as strong,effective and high resistance barrier and prevention of mother-to-child transmission(MTCT)of HBV among various hospitals.And the affordability of the originator brands drugs and equivalent lowest price g,enerics drugs.2.Statistical methodsAll data in the research process were recorded by EXCEL,statistical analysis were conducted using IBM SPSS Statistics 19.0(IBM.Armonk,NY.USA),and the figures were drawn using the GraphPad Prism software package(version 5 for Windows;GraphPad software,San Diego,CA).Categorical variables were expressed as n(%)and pearson ?2 test.All statistical analysis were based on the two-tailed hypothesis tests,and the criterion for statistical significant was set at P<0.05.Results1.Basic situation of the hospital under investigationIn this study,a total of 133 public hospitals at the municipal or county level of yunnan province were surveyed.The 118 cities or counties responded to the survey information(88.72%,118/133),including 21 border counties(84.00%,21/25).Data feedback was provided to 16 state and municipal general hospitals(100%,16/16)and 102 county-level general hospitals(87.18%,102/117),including 18 county-level hospitals without independent infection departments.Of the 102 county-level hospitals,71.57%(73/102)had two or less anti-HBV drugs,and the top three drugs with high ownership rate were entecavir(ETV)59.80%(61/102),lamivudine(LAM)57.84%(59/102)and common interferon 31.37%(32/102).2.Anti-HBV drugs with the peculiarities of high resistance barrierIn all survey hospitals,county level hospitals were significantly lower than state and municipal hospitals(60.78%vs.93.75%,?2=6.63,P=0.0100).County hospitals without independent infection department were siginficantly lower than those with independent infection department(22.22%vs.69.05%,?2=13,64,P=0.0002).3.Anti-HBV drug to prevent mother-to-child tra-smission(MTCT)The county hospitals tenofovir disoproxil fumarate(TDF)and telbivudine(LdT)were also significantly lower-than state and municipal hospitals(11.76%vs.81.25%,P<0.0001).If LAM is included in the prevention of MTCT drugs,the increase is 5.25 Times(61.76%vs.11.76%;?2=34.79,p<0.00001)4.Comparison of the affordability of anti-HBV originator brands drugs and equivalent lowest price generics drugsThe affordability of anti-HBV original drug was lower than that of equivalent generic drugs(10.6 days vs.8.5 days).ConclusionThe availability of anti-HBV drugs in yunnan province is greatly different from that in county-level hospitals.The low availability of anti-HBV drugs in county-level hospitals may affect the nearest access to standardized diagnosis and treatment for HBV infected patients.The affordability of both the Originator brands drugs and equivalent lowest price generics drugs was poor.