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NPS analysis of medications for PrEP using PBS Data

Page last updated: 24 March 2022

Drug utilisation sub-committee (DUSC)

October 2021

Abstract

Purpose

DUSC requested a review of the utilisation of medicines used for the treatment of Human Immunodeficiency Virus (HIV) and for pre-exposure prophylaxis (PrEP) of HIV at its June 2021 meeting. The analyses in this report are for PrEP and are based on PBS data.

Data Source / methodology

Data for all medicines used for PrEP listed on the PBS were extracted from the Services Australia PBS supplied prescriptions database for the 3 years from April 2018 to March 2021.

Key Findings

  • Between 1 April 2018 and 31 March 2021, a total of 352,427 prescriptions for PrEP were dispensed for 44,303 patients.
  • There was an 80.8% increase in the number of prescriptions for PrEP dispensed between the first and second years since PBS listing, from 77,512 to 140,142 prescriptions.
  • There were 134,773 prescriptions for PrEP dispensed in the third year since listing (1 April 2020 to 31 March 2021), representing a 3.8% reduction compared to the second year, likely explained by the impacts of the COVID-19 restrictions.
  • In the third year since listing, the cost to government for PrEP was $11.4 million, a decrease of $8.9 million when compared to expenditure on PrEP in the first year since listing, due to price disclosure reductions.
  • In the third year since listing, approximately 77.9% of dispensed prescriptions for PrEP were prescribed by GPs. Specialists accounted for another 11.3% of prescriptions and nurse prescribers 1.2% of prescriptions each year, with a further 9.6% of prescriptions with unassigned or missing prescriber details.
  • In the first year since PBS listing, 22,403 patients were dispensed a PrEP prescription at least once, increasing by 39.1% in the second year to 31,159 people and 31,124 people in the third year since listing.
  • The number of patients newly dispensed a PrEP prescription decreased year on year from 22,403 patients in the first year since listing to 8640 patients in the third year.
  • The annual number of patients dispensed PBS-subsidised PrEP under the Closing the Gap program increased from 218 patients in the first year since listing to 443 patients in the third year (noting these findings will underestimate the true rate of dispensing to Aboriginal and Torres Strait Islander people).
  • Sociodemographic characteristics were similar for patients prescribed PrEP during the first 18 months since PBS listing and the following 18 months. These results were mirrored in the companion MedicineInsight analysis.
    • Across both time periods, most patients dispensed PBS-subsidised PrEP were male (98.7%) and the mean age was 37.1 years.
    • Supply of PrEP was highest among patients aged 30–39 years followed by those aged 20–29 years.
    • Four fifths of patients dispensed PrEP resided in a major city and approximately 11% resided in inner regional areas, with most patients residing in NSW or Victoria
    • A slightly higher proportion of patients accessed PrEP via the Closing the Gap subsidy program in the latter 18-month period (1.7% compared with 1.3%).
  • Patients had a mean average of 8.0 prescriptions for PrEP over the 3-year study period or 4.4 prescriptions per person-year, which equates to a medication possession ratio (MPR) of 36.7%. This finding was much lower when compared to the MPR of 80.8% in the MedicineInsight report on prescribing and might be explained by an increase in on-demand use since the guideline change in 2020, non-adherence, changes in behaviour since COVID-19 restrictions or access to PrEP via self-importation (the cost of which is now less than the PBS-subsidised general patient co-payment).
  • The mean duration of PrEP use was 1.8 years, similar to the MedicineInsight report at 1.5 years.
  • Among 29,569 patients identified as having a gap in PrEP use >21 days, the mean time to first discontinuation was 110 days.
  • Among 44,303 patients dispensed PrEP during the 3-year period, a fifth (19.6%) were only dispensed PrEP once, 13.7% had continuous supply and two thirds (66.7%) had non-continuous supply (i.e. one or more gaps of >21 days during the 3 years)
  • According to the PBS data non-continuous PrEP use appears to be more common than continuous use, whereas a similar proportion of patients in the MedicineInsight report appeared to have continuous or non-continuous PrEP use.
  • The analysis of PrEP user status at 31 March 2021 found that 54.0% had a current prescription and 46.0% had discontinued PrEP.
  • The proportion of new HIV diagnoses in patients, at least 31 days following PrEP initiation, was 0.2 per 100 person-years (95% CI 0.2–0.3); higher than the incidence seen in the EPIC-NSW study (0.048 per 100 person-years; 95% CI 0.012–0.195) and similar to the accompanying MedicineInsight report (0.3 per 100 person-years; 95% CI 0.2–0.5)

Full Report