title: Impact of a new reimbursement program on hepatitis B antiviral medication cost and utilization in Beijing, China.
abstract: BACKGROUND
  Hepatitis B virus (HBV) infection is a significant clinical and financial burden for chronic hepatitis B (CHB) patients. In Beijing, China, partial reimbursement on antiviral agents was first implemented for the treatment of CHB patients in July 1, 2011.
  
  
  OBJECTIVE
  In this study, we describe the medical cost and utilization rates of antiviral therapy for CHB patients to explore the impact of the new partial reimbursement policy on the medical care cost, the composition, and antivirals utilization.
  
  
  METHODS
  Clinical and claims data of a retrospective cohort of 92,776 outpatients and 2,774 inpatients with non-cirrhotic CHB were retrieved and analyzed from You'an Hospital, Beijing between February 14, 2008 and December 31, 2012. The propensity score matching was used to adjust factors associated with the annual total cost, including age, gender, medical insurance type and treatment indicator.
  
  
  RESULTS
  Compared to patients who paid out-of-pocket, medical cost, especially antiviral costs increased greater among patients with medical insurance after July 1, 2011, the start date of reimbursement policy. Outpatients with medical insurance had 16% more antiviral utilization; usage increased 3% among those who paid out-of-pocket after the new partial reimbursement policy was implemented.
  
  
  CONCLUSIONS
  Direct medical costs and antiviral utilization rates of CHB patients with medical insurance were higher than those from paid out-of-pocket payments, even after adjusting for inflation and other factors. Thus, a new partial reimbursement program may positively optimize the cost and standardization of antiviral treatment.
authors.affiliation: Dept of Epidemiology and Biostatistics, Institute of Basic Medical Sciences Chinese Academy of Medical Sciences, School of Basic Medicine Peking Union Medical College, Beijing, China.
authors.forename: Qian
authors.initials: Q
authors.lastname: Qiu
authors.affiliation: Liver center, Beijing You'an Hospital of Capital Medical University, Beijing, China.
authors.forename: Yan
authors.initials: Y
authors.lastname: Li
authors.affiliation: Liver center, Beijing You'an Hospital of Capital Medical University, Beijing, China.
authors.forename: Xiao-wan
authors.initials: XW
authors.lastname: Duan
authors.affiliation: Liver center, Beijing You'an Hospital of Capital Medical University, Beijing, China.
authors.forename: Li-kun
authors.initials: LK
authors.lastname: Yang
authors.affiliation: Liver center, Beijing You'an Hospital of Capital Medical University, Beijing, China.
authors.forename: Yu
authors.initials: Y
authors.lastname: Chen
authors.affiliation: Dept of Epidemiology and Biostatistics, Institute of Basic Medical Sciences Chinese Academy of Medical Sciences, School of Basic Medicine Peking Union Medical College, Beijing, China.
authors.forename: Hui
authors.initials: H
authors.lastname: Li
authors.affiliation: Dept of Epidemiology and Biostatistics, Institute of Basic Medical Sciences Chinese Academy of Medical Sciences, School of Basic Medicine Peking Union Medical College, Beijing, China.
authors.forename: Li
authors.initials: L
authors.lastname: Wang
authors.affiliation: Liver center, Beijing You'an Hospital of Capital Medical University, Beijing, China.
authors.forename: Zhong-ping
authors.initials: ZP
authors.lastname: Duan
mesh_terms: D000998:Antiviral Agents / Q000191:economics* / Q000627:therapeutic use*; D002681:China; D016527:Drug Costs / Q000706:statistics & numerical data*; D004363:Drug Utilization / Q000191:economics*; D005260:Female; D006296:Health Services / Q000191:economics / Q000706:statistics & numerical data; D019694:Hepatitis B, Chronic / Q000188:drug therapy* / Q000191:economics*; D006761:Hospitals / Q000706:statistics & numerical data; D006801:Humans; D007349:Insurance, Health, Reimbursement / Q000706:statistics & numerical data*; D008297:Male; D012189:Retrospective Studies
chemical_list: D000998:Antiviral Agents