Trends in Use of Direct-Acting Antivirals for Treatment of Hepatitis C Virus Infection in Australia 2016–2024

Abstract

Direct-acting antivirals (DAAs) have transformed hepatitis C virus (HCV) treatment in Australia since their inclusion on the Pharmaceutical Benefits Scheme (PBS) in 2016. Treatment has shifted from genotype-specific to pan-genotypic regimens, with glecaprevir/pibrentasvir and sofosbuvir/velpatasvir now recommended in clinical guidelines. This study examined trends in DAA dispensing in light of evolving treatment regimens. A retrospective analysis of publicly available PBS data was conducted, assessing monthly DAA dispensings from March 2016 to December 2024. Dispensings were summarised by count and proportion, PBS item code, schedule (general, private, or public hospital) and number of repeats as a proxy for treatment duration. Dispensing volumes of DAAs increased following PBS-listing in March 2016, with the highest number of dispensings observed between 2016 and 2017 (average of 11,378 prescriptions dispensed per month). Dispensing rates subsequently declined, with an average of 1583 prescriptions dispensed per month from 2020 to 2024. Since introduction to market in August 2017, sofosbuvir with velpatasvir (pan-genotypic regimen) has maintained an average market share of 55%. Glecaprevir/pibrentasvir (pan-genotypic regimen) has maintained an average market share of 34% since its introduction in August 2018. Sofosbuvir/velpatasvir/voxilaprevir, listed on the PBS in April 2019, and used for salvage therapy, has had a smaller average market share of 4% since listing. Pan-genotypic regimens now account for nearly all DAA use in Australia. Declining dispensing rates may reflect reduced new infections and treatment fatigue. Increasing retreatment rates underscore the need for ongoing monitoring and real-world evaluations. Future head-to-head comparisons may support optimal regimen selection.