Impact of partial reimbursement on hepatitis B antiviral utilization and adherence

Table 1 Patient characteristics before and after propensity score matching

	Before matching		After matching
	Cohort 1 (n = 14163)	Cohort 2 (n = 16228)	Cohort 1 (n = 13364)	Cohort 2 (n = 13364)
Age (mean ± SD)b	38.2 ± 12.6	39.6 ± 12.6	38.7 ± 12.6	38.9 ± 12.4
Male (%)b	67.7	64.7	66.7	66.5
Insurance type (%)b
Medical insurance	40.6	52.4	42.9	42.6
Out-of-pocket	58.2	47.0	56.3	56.6
Others	1.3	0.6	0.7	0.8
Disease statusb
Yes1	29.3%	23.6%	28.2%	27.9%

¹Having one of the following characteristics: (1) serum alanine aminotransferase (ALT) over two times upper limit of normal (ULN); (2) hepatitis B virus (HBV) DNA ≥ 20000 IU/mL for hepatitis B e antigen (HBeAg) (+) patients; or (3) HBV DNA ≥ 2000 IU/mL for HBeAg (-) patients. ANOVA was performed to compare age difference between cohort 1 vs cohort 2; χ² test was conducted to compare male (%), insurance type (%) and disease status between cohort 1 vs cohort 2.

^bP < 0.01, cohort 1 vs cohort 2.

Table 2 Medication possession ratio and good adherence rate among patients with different insurance types before and after reimbursement

			Adherence (%)			Good adherence rate
		n	mean ± SD	New patients	Existing patients	Percent	New patients	Existing patients
Before	PMI	2825	83.4 ± 24.3a	82.3 ± 25.6d	84.5 ± 22.9d	70.6%	69.2	71.8
	PPO	3373	83.6 ± 24.2b	83.6 ± 24.8	83.6 ± 23.7	70.2%	70.5	69.9
After	PMI	4102	88.5 ± 19.7ac	87.1 ± 20.8e	90.2 ± 18.1e	79.2%g	77.0h	82.1h
	PPO	3619	85.2 ± 23.0bc	84.0 ± 24.1f	86.1 ± 22.1f	73.1%g	71.7	74.2

^aP < 0.01 among PMI before reimbursement vs after reimbursement;

^bP < 0.01 among PPO before reimbursement vs after reimbursement;

^cP < 0.01 between PMI and PPO after reimbursement;

^dP < 0.05 between new and existing PMI before reimbursement;

^eP < 0.01 between new and existing PMI after reimbursement;

^fP < 0.01 between new and existing PPO after reimbursement;

^gP < 0.01 between PMI and PPO after reimbursement;

^hP < 0.01 between new and existing PMI after reimbursement. PMI: Patients with medical insurance; PPO: Patients paid out-of-pocket.

Table 3 Factors associated with good adherence

Parameter	β	OR (95%CI)
Age (yr)
18-45 vs ≤ 18a	-0.3297	0.719 (0.559-0.926)
> 45 vs ≤ 18b	-0.4048	0.667 (0.513-0.867)
Gender (1 = male; 0 = female)	-0.0382	0.963 (0.886-1.046)
Insurance type (1 = medical insurance; 0 = paid out-of-pocket)	0.1200	1.128 (0.987-1.288)
Disease status (1 =; 0 = reference;)b	0.2516	1.286 (1.164-1.422)
Patient status (1 = new patients; 0 = existing patients)	-0.0341	0.966 (0.860-1.086)
Reimbursement implementation (1 = Yes; 0 = No)b	0.1502	1.162 (1.047-1.290)
Insurance type patient statusa	-0.1980	0.820 (0.703-0.957)
Insurance type reimbursement implementationb	0.3518	1.422 (1.220-1.657)

^aP < 0.05;

^bP < 0.01, new vs existing patients. 1 = having one of the following characteristics: (1) serum alanine aminotransferase over two times upper limit of normal; (2) alanine aminotransferase DNA ≥ 20000 IU/mL for hepatitis B e antigen (HBeAg) (+) patients; or (3) HBV DNA ≥ 2000 IU/mL for HBeAg (-) patients.

Table 4 Characteristics of patients receiving questionnaire survey

	Insurance (n = 152)	Out-of-pocket (n = 60)
Age (yr)	38.8 ± 8.3	39.7 ± 11.6
Male (%)	99 (65.1)	38 (64.4)1
Income (Yuan)
Median (Q25-Q75)	4000 (2500, 6300)	3000 (1500, 5000)
Antivirals obtaining outside You’an Hospital only (%)
Before reimbursement	9.8	10.8
After reimbursement	5.9	10.2

¹The number is 59.