Background: There is considerable variation in reimbursement policies in Asian countries and this is likely to have an impact on treatment practice for chronic hepatitis B (CHB). Consequently a survey of leading hepatologists was performed to evaluate such policies and their impact on management of CHB in the Asia Pacific region.Methods: A questionnaire was sent to key hepatologists in Asia Pacific for information on CHB reimbursement policy—its nature, coverage, funding source, duration, review strategy and impact on Asia Pacific Association for the Study of the Liver (APASL) CHB guidelines. The results were analysed and described.Results: Leading hepatologists from 16 Asia Pacific countries responded. Almost all of the countries have reimbursement policies but eligibility varied from only a limited group (e.g. civil servants only) to universal access. In most instances reimbursement was from the central government (except China, Pakistan and Hong Kong). Reimbursement policies were usually created by Ministry of Health committees, who received input from medical professionals, although they may not be aware of the APASL guidelines. Policies were limited by available resources, funds and prioritization. Where there was a regular review this occurred between 1 and 5 years. The quantum of reimbursement varied from 50 % in Singapore to 100 % in the majority of other countries. The criteria for treatment reimbursement were based on doctor’s opinion alone (Bangladesh, India, Pakistan, Philippines, Singapore and Vietnam) or specific clinical/laboratory criteria in the rest of the countries. In general, most countries offered unlimited duration for reimbursement except Taiwan, Indonesia and Pakistan. Monitoring tests for treatment response were reimbursed in all countries other than Vietnam. Viral resistance was diagnosed by viral or biochemical breakthrough, and viral resistance testing was uncommon. The main rescue therapy was adefovir.Conclusion: Reimbursement policies differed from country to country, the quantum and the proportion of patients who received reimbursement also varied significantly. Asia Pacific countries were able to follow APASL guidelines with variable success based on their reimbursement policies.
Bibliographical noteFunding Information:
This article does not contain any studies with human or animal subjects. SG Lim is on the advisory board of Novartis, Merck Sharp and Dohme (MSD), Janssen, Achillion and Bristol-Myers Squibb (BMS) Pharmaceuticals, and is on the speakers’ bureau for GlaxoSmithKline (GSK), Novartis and BMS Pharmaceuticals. JH Kao is a consultant for Abbott, Abbvie, Bayer, Boehringer Ingelheim (BI), BMS, Gilead Sciences, GSK, Johnson & Johnson (JJ), MSD, Novartis, and Roche Pharmaceuticals, and is on the speakers’ bureau for Abbott, Roche, Bayer, BMS, GSK and Novartis Pharmaceuticals. JD Jia is a consultant and speaker for BMS, MSD, Novartis and Roche Pharmaceuticals. Piratvisuth T is on the advisory board and holds a research grant from Roche, BMS, MSD and Novartis Pharmaceuticals, and is on the speakers’ bureau for Roche, BMS, MSD, GSK and Novartis Pharmaceuticals. Ed Gane is on the advisory board of Achillion, Idenix, Gilead, Novartis, Roche, MSD and Janssen Pharmaceuticals, and is on the speakers’ bureau for Janssen, Gilead, Novartis Pharmaceuticals. Amarapurkar D is a consultant for Abott, Janssen, BMS Pharmaceuticals, and is on the speakers’ bureau for Novartis, Bayer and Roche Pharmaceuticals. Crawford D is on the advisory board of Gilead Sciences. Henry Chan is a speaker for BMS, Gilead, Novartis, Roche, Echosens, GSK, Abbvie Pharmaceuticals, advisor for BMS, Gilead, Novartis, Roche and MSD Pharmaceuticals, and has an unrestricted research grant from Roche. Keat Hong Lee, Kwang-Hyub Han, Sang Hoon Ahn, Wasim Jafri, Laurentius A. Lesmana, C. Rinaldi A. Lesmana, Rosmawati Mohamed, Pham Hoang Phiet, Shiv K. Sarin, Jose D. Sollarno, Yuichiro Eguchi and Mamun-Al-Mahtab declare no conflict of interests.
© 2014, Asian Pacific Association for the Study of the Liver.
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