Australian Pharmaceutical Benefits Scheme Research Articles

Long-acting reversible contraception prescribing coverage by nurse practitioners and midwives in Australia

BackgroundExpanded patient access to long-acting reversible contraception (LARC) is needed to support patient choice and access to efficacious forms of contraception. Little is known about nurse practitioner (NP) and midwife LARC prescribing. AimsTo examine LARC prescribing by NPs and midwives in Australia. MethodsA cross-sectional study of Australian Pharmaceutical Benefits Scheme dispensing data from 2018 to 2021 for females aged 15–54. Age‐standardised rates were calculated by state, remoteness area, and level 3 statistical areas (SA3s). FindingsDespite a 1.6 fold increase since 2018, NPs and midwives accounted for 0.82 % (n = 2184) of prescriptions for LARC dispensed in 2021. The percentage of services in 2021 was greater in outer regional (2.21 %) and lowest in major cities (0.68 %) and was higher for the implant (0.92 %) compared with the hormonal intrauterine device (0.76 %). The proportion of total SA3s where a NP/midwife prescribed LARC increased from 23.35 % in 2018 to 29.94 % in 2021. NP/midwife LARC prescribing was highest in outer regional (42.6 %) and lowest in remote areas (18.8 %). When stratified by state/territory, coverage of SA3s was highest in Australian Capital Territory (50.0 %) and lowest in the Northern Territory (11.1 %). Discussion and conclusionOur findings suggest that whilst there has been an increase in NP and midwife LARC prescribing, the overall rate remains low and coverage across Australia appears fragmented. NPs and midwives are well placed to enhance women’s access to efficacious forms of contraception, but this requires future efforts to identify and address critical barriers (e.g. legislative, funding, training) to service provision.

Cohort profile: POPPY II – a population-based cohort examining the patterns and outcomes of prescription opioid use in New South Wales, Australia

PurposeThe POPPY II cohort is an Australian state-based cohort linking data for a population of individuals prescribed opioid medicines, constructed to allow a robust examination of the long-term patterns and...

Have changing practices in salvage medical options affected colectomy rates in acute severe ulcerative colitis?

In 2014, infliximab (IFX) was listed on the Australian Pharmaceutical Benefits Scheme for acute severe ulcerative colitis (ASUC) and is now the preferred option for medical salvage, superseding cyclosporin A (CsA). Optimal dosing schedules for IFX remain unknown. The authors aim to evaluate the effect of changing from predominantly CsA to almost exclusively IFX for the treatment of steroid-refractory ASUC on colectomy rates. A retrospective review was performed of patients admitted with ASUC between 2012 and 2020. Patients were categorised into two groups according to year of presentation - either 'historical treatment' cohort (2012-2014), when CsA was primarily used, or 'contemporary treatment' cohort (2014-2020), when IFX was mostly prescribed, in either standard or intensive doses. One hundred thirty-nine patients were included; 37 in the historical treatment cohort and 102 in the contemporary treatment cohort. In the historical treatment cohort, 12 of 37 received salvage therapy and eight (67%) received CsA. In the contemporary treatment cohort, 49 of 102 patients received salvage therapy, 40 (82%) with IFX, of whom 22 (53%) received intensified doses. Colectomy rates were similar at 30 days, 6 months and 12 months between historical and contemporary treatment cohorts (14% vs 12% [P = 0.77], 19% vs 18% [P > 0.99],and 22% vs 18% [P = 0.63], respectively). Difference in 12-month colectomy rates between standard versus intensive IFX did not meet statistical significance (three of 21 [14%] vs nine of 22 [41%]. respectively; P = 0.09). There was no difference in 30-day, 6-month or 12-month colectomy rates between the historical treatment and contemporary treatment cohorts. The use of IFX, rather than CsA, even at intensified dosing, does not appear to reduce the colectomy rate observed in our patients.

Lithium Dispensed for Adults Aged ≥ 50 Years Between 2012 and 2021: Analyses of a 10% Sample of the Australian Pharmaceutical Benefits Scheme

BackgroundLithium use seems to be declining in clinical practice. We examined the proportion of adults aged ≥ 50 years dispensed lithium between 2012 and 2021, and investigated the proportion of lithium users dispensed other medications. MethodsWe used a 10% random sample data of the Australian Pharmaceutical Benefits Scheme from 2012 to 2021, and limited our analyses to adults aged ≥ 50 years. We retrieved data on lithium, other mood stabilisers, antipsychotics, antidepressants, anxiolytics and hypnotics, and medications for the treatment of other health systems. ResultsWe received 7081939 person-years records (53.2% women). The proportion of participants dispensed lithium decreased with age: 0.4% for those aged 50-59 years to < 0.1% for people aged ≥ 90 years. The dispensing of lithium increased over 10 years for those aged 50-69 and decreased in those older than 80 years. Among people dispensed lithium, nearly 1 in 5 were dispensed another mood stabiliser. Antipsychotics and antidepressants were dispensed to about 60% of participants dispensed lithium, with antidepressants dispensed more frequently to women than men. About 20% of people dispensed lithium were dispensed anxiolytics/hypnotics, more frequently for women than men. Medications to treat diseases of the alimentary, cardiovascular, endocrine and nervous systems were commonly dispensed to those dispensed lithium, as were antibiotics. ConclusionsWhile the dispensing of lithium increased among young older adults since 2015 when guidelines for the management of mood disorders were published, our findings suggest that lithium may be under-utilised for the management of bipolar disorder in later life.

PATTERNS AND PREDICTORS OF OUTPATIENT ANTIBIOTIC DISPENSATION FOLLOWING TOTAL HIP AND KNEE ARTHROPLASTY

This study aimed to evaluate the month-to-month prevalence of antibiotic dispensation in the 12 months before and after total knee arthroplasty (TKA) and total hip arthroplasty (THA) and to identify factors associated with antibiotic dispensation in the month immediately following the surgical procedure.In total, 4,115 THAs and TKAs performed between April 2013 and June 2019 from a state-wide arthroplasty referral centre were analysed. A cross-sectional study used data from an institutional arthroplasty registry, which was linked probabilistically to administrative dispensing data from the Australian Pharmaceutical Benefits Scheme. Multivariable logistic regression was carried out to identify patient and surgical risk factors for oral antibiotic dispensation.Oral antibiotics were dispensed in 18.3% of patients following primary TKA and 12.0% of patients following THA in the 30 days following discharge. During the year after discharge, 66.7% of TKA patients and 58.2% of THA patients were dispensed an antibiotic at some point. Patients with poor preoperative health status were more likely to have antibiotics dispensed in the month following THA or TKA. Older age, undergoing TKA rather than THA, obesity, inflammatory arthritis, and experiencing an in-hospital wound-related or other infectious complications were associated with increased antibiotic dispensation in the 30 days following discharge.A high rate of antibiotic dispensation in the 30 days following THA and TKA has been observed. Although resource constraints may limit routine wound review for all patients by a surgeon, a select cohort may benefit from timely specialist review postoperatively. Several risk factors identified in this study may aid in identifying appropriate candidates for such changes to follow-up care.

P656 Superior treatment persistence with ustekinumab in biologic-experienced luminal Crohn’s disease: real-world registry data from the Persistence Australian National IBD Cohort (PANIC) study

Abstract Background Ustekinumab has been shown equivalent to adalimumab in the treatment of biologic-naïve patients with Crohn’s disease (CD) at 1 year. However the real world persistence of these medications, and particularly when used sequentially in biologic-experienced patients is unknown. Prescription data provides real-world evidence about treatment efficacy, tolerability and prescriber and patient acceptability. Methods Persistent of medication was analysed from the Australian Pharmaceutical Benefits Scheme (PBS) registry data 2005-2019 for luminal Crohn’s disease, using a 10% representative sample. Results There were 2029 patients over the 15 year period with 5618 years of patient follow up. The median age was 43 years (interquartile range (IQR): 34-58), with 891/2029 (43.9%) male. Via therapy, 915/2029 (45.1%) were on adalimumab, 722/2029 (35.6%) were on infliximab 155/2029 (7.6%) were on vedolizumab, and 237/2029 (11.7%) were on ustekinumab. Used as a first-line biologic (bio-naïve), there was no difference between any agent for persistence (p&amp;gt;0.05). Used after first-line (bio-experienced), ustekinumab had significantly better persistence than TNFa inhibitors (TNFi) (p= 0.006) and vedolizumab (p&amp;lt;0.001), additionally vedolizumab had poorer persistence than TNFi (p=0.028). In bio-experienced patients, ustekinumab persistence was greater than non-ustekinumab biologic agents (p= 0.0018). TNFi persistence was significantly poorer in bio-experienced vs naïve patients (p=0.042), with a non-significant trend for poorer outcomes in vedolizumab (p= 0.059), but did not differ for ustekinumab (p=0.509). Used after a TNFi agent, ustekinumab had superior persistence to an alternative TNFi agent (p=0.033). Using a propensity score matched analysis for age, immunomodulator use and line of therapy, ustekinumab had superior to persistence to non-ustekinumab agents (p=0.0044) and to TNFi (p=0.01). Multivariate predictors of loss of persistence were biologic used (adjusted hazard ratios (aHR): 0.84, p=0.001), and line of therapy (aHR: 1.16, p=0.003). Conclusion The PANIC cohort with real-world data of non-hierarchical prescribing of biological agents does not support the superiority of any agent in biologic-naïve luminal CD. However for biologic experienced, the persistence is greater with ustekinumab than TNFa inhibitors, and vedolizumab persistence is significantly poorest. These findings will assist in the positioning of biological therapies in luminal CD.

Reduction in Herpes Zoster Antiviral Use Since the Introduction of the Live-Attenuated Zoster Vaccine on Australia's National Immunisation Program: A Population-Based Study from 1994 to 2019.

Zostavax, the live-attenuated vaccine used to prevent herpes zoster (HZ), has been available to individuals aged 70 and 71-79years (phased catch-up) via Australia's National Immunisation Program (NIP) since 2016. There are limited data characterising the incidence of HZ at the level of the Australian population. National prescription data for antivirals used to treat HZ may be used as a proxy for HZ incidence. We aimed to examine trends in antiviral prescriptions supplied for the treatment of HZ in Australia pre- and post-2016, and to assess whether Zostavax's inclusion on the NIP correlated with a reduction in HZ antiviral prescription rates. Using the Australian Pharmaceutical Benefits Scheme and Repatriation Pharmaceutical Benefits Scheme prescribing data, we analysed antiviral prescriptions supplied for the treatment of HZ Australia-wide between 1994 and 2019. Annual prescription rates were calculated, and trends and changes in HZ antiviral use were explored descriptively and using Poisson models. HZ antiviral prescription rates increased 2.6-fold (160%) between 1995 and 2015 [25.4 (95% CI 25.2, 25.6) and 65.3 (95% CI 64.9, 65.6) prescriptions per 10,000 people, respectively], and then decreased 0.45-fold (55%) between 2016 and 2018 [60.9 (95% CI 60.6, 61.2) and 27.5 (95% CI 27.3, 27.9) prescriptions per 10,000 people, respectively]. The prescription rate for the antiviral famciclovir restricted specifically for treating HZ in immunocompromised individuals increased 8.5-fold (750%) between 2006 (year first listed) and 2019 [0.3 (95% CI 0.3, 0.3) and 2.5 (95% CI 2.4, 2.6) prescriptions per 10,000 people, respectively]. The introduction of the live-attenuated HZ vaccine on Australia's formal national vaccination program was associated with a reduction in HZ antiviral prescription rates within the Australian population. The data suggest that the introduction of Shingrix, the non-live subunit zoster vaccine, may also be associated with a similar reduction in HZ antiviral prescriptions used to treat the immunocompromised, as well as the general population, given its accepted greater efficacy over Zostavax.

The prevalence of rheumatoid arthritis in Western Australia

BackgroundRheumatoid arthritis (RA) is the most common form of autoimmune arthritis, but the prevalence in Australia is unknown. We estimated RA period prevalence and identified factors associated with frequent RA hospitalisations, using linked administrative health and state-specific Australian Pharmaceutical Benefits Scheme (PBS) datasets in Western Australia (WA) from 1995 to 2014.MethodsThis was a longitudinal population-based cohort study using two independent datasets to identify prevalent RA patients. RA prevalence was calculated per 1000 hospital separations and biological therapy users. RA patients were identified in the WA linked health dataset using ICD codes 714.0–714.9 and M05.00–M06.99. Dispensing data on biological therapy for RA were obtained from PBS records and converted to defined daily doses /1000 population/day. Multivariable logistic regression was used to analyse factors associated with frequent RA hospitalisations (> 2/year), controlling for sex, age, and geographic locations. Potential interactions were assessed using logistic regression in a stepwise approach.ResultsA total of 17,125 RA patients had 50,353 hospital separations between 1995 and 2014, averaging three hospitalisations per patient over 20 years. The RA period prevalence was 3.4 per 1000 separations (0.34%; 95% CI 0.33–0.34), while the RA period prevalence based on biological therapy use was 0.36% (95% CI 0.35–0.37). The corrected RA prevalence based on biological therapy usage was 0.36% (95% CI 0.35–0.37) for the 2005–2009 and increased to 0.72% (95% CI 0.70–0.74) in 2010–2014 period. Associated factors for frequent RA hospitalisations were being female [1.21 (95% CI 1.15–1.26)], aged 60–69 years [4.45 (95% CI 3.74–5.30)], living in rural areas [1.12 (95% CI 1.02–1.24)]. The odd ratio of interaction between these associated factors was 1.34 (95% CI 1.16–1.55).ConclusionThe minimal prevalence of RA in Western Australia is 0.34–0.36%, which falls within the literature range. Older female RA patients in rural were more likely to be hospitalised, suggesting unmet primary care for needs.

Persistence and adherence to second-generation antipsychotic long-acting injectable medications for schizophrenia: A comparative study in the Australian context

To examine patient characteristics, persistence and adherence to treatment associated with use of second-generation antipsychotic long-acting injectable (SGA LAI) medications in the Australian real-world setting. Five SGA LAIs were compared using a retrospective 10% sample of prescriptions in Australian Pharmaceutical Benefits Scheme (PBS) data: paliperidone palmitate 1-monthly (PP1M), paliperidone palmitate 3-monthly (PP3M), aripiprazole monohydrate (ARI), risperidone (RLAI) and olanzapine pamoate (OLAI). Patients in the PP3M cohort were more persistent with treatment (p < 0.001). Median months of persistence: PP3M (36months); ARI (18months); PP1M (11months); OLAI (8months); RLAI (4months). Patients in the PP3M cohort were more adherent to treatment (p < 0.001): PP3M (78%); ARI (51%); PP1M (46%); OLAI (35%); RLAI (33%). Patients on PP3M treatment showed comparatively longer persistence and better adherence. Treatments for schizophrenia with longer dosing intervals may provide patients with symptomatic stability that could allow for reduced hospitalisations/relapse and increased focus on functional recovery.

EISI: Extended inter-spike interval for mental health patients clustering based on mental health services and medications utilisation.

Mental health is vital in all human life stages, and managing mental healthcare service resources is crucial for providers. This paper presents a new method, called Extended Inter-Spike Interval (EISI), on identifying the patients with a similar utilisation of mental health services and medications. The EISI measures the distance between the utilisation patterns of the patients. Then, the pairwise distances are given to a developed split-and-merge Partitioning Around Medoids (PAM) clustering algorithm to identify the patients with similar utilisation patterns. To evaluate the proposed method, we use two years (2013-2014) of the 10% publicly available sample of the Australian Medicare Benefits Schedule (MBS) and Pharmaceutical Benefits Scheme (PBS) administrative data. Results show that mental health patients can be grouped into ten clusters with distinct and interpretable utilisations patterns. The largest cluster comprises individuals who only visit general practitioners and take psycholeptics medications for a short time. The smallest group contains occasional visits with general practitioners and regularly utilises psycholeptics and psychoanaleptics medications over long periods. The proposed method provides insights on whom to target and how to structure services for different groups of individuals with mental health conditions.

205MO Patterns of treatment and outcomes in MCL patients in Australia: An analysis of the population-wide pharmaceutical benefits scheme dataset

There is limited information on the patient characteristics and outcomes of people with mantle cell lymphoma (MCL), or the treatment strategies adopted to their management in the Australian real-world setting. The purpose of this study was to describe the treatment patterns and outcomes of people with MCL who receive treatment under the Australian Pharmaceutical Benefits Scheme (PBS).

Antibiotic utilisation in primary and revision total hip replacement patients: A registry linkage cohort study of 106 253 patients using the Australian Orthopaedic Association National Joint Replacement Registry.

Infection is a major complication following joint replacement (JR) surgery. However, little data exist regarding antibiotic utilisation following primary JR and how use changes with subsequent revision surgery. This study aimed to examine variation in antibiotic utilisation rates before and after hip replacement surgery in those revised for infection, revised for other reasons and those without revision. This retrospective cohort analysis used linked data from the Australian Orthopaedic Association National Joint Replacement Registry and Australian Government Pharmaceutical Benefits Scheme. Patients were included if undergoing total hip replacement (THR) for osteoarthritis in private hospitals between 2002 and 2017. Three groups were examined: primary THR with no subsequent revision (n=102 577), primary THR with a subsequent revision for reasons other than periprosthetic joint infection (PJI) (n=3156) and primary THR with a subsequent revision for PJI (n=520). Monthly antibiotic utilisation rates and prevalence rate ratios (PRRs) with 95% confidence intervals (CIs) were calculated in the 2 years pre- and post-THR. Prior to primary THR antibiotic utilisation was 9%-10%. After primary THR, antibiotic utilisation rates were higher among patients revised for PJI (PRR 1.69, 95% CI 1.60-1.79) compared to non-revised patients, while the utilisation rate was lower in patients revised for reasons other than infection (PRR 0.96, 95% CI 0.93-0.98). For those revised for infection, antibiotic utilisation post-revision surgery was two times higher than those revised for other reasons (PRR 2.16, 95% CI 2.08-2.23). Utilisation of injectable antibiotics including, vancomycin, flucloxacillin and cephazolin was higher in those revised for PJI patients 0-2 weeks following surgery but not in those revised for other reasons compared to the non-revised group. Ongoing antibiotic utilisation after primary surgery may be an early signal of problems with the THR and should be a prompt for primary care physicians to refer patients to specialists for further appropriate investigations and management.

Trends in dispensing and utilisation of sustained-release tapentadol in Australia.

ObjectivesTapentadol is a µ-opioid agonist, moderate noradrenaline reuptake inhibitor (NRI) and very weak serotonin reuptake inhibitor. The sustained release (SR) formulation is indicated for relief of chronic moderate to severe pain. We examined utilisation trends and concordance with prescribing guidelines of prescription SR tapentadol in Australia between 2014-2021. ApproachWe used a 10% sample of Australian Pharmaceutical Benefits Scheme dispensing data linked to death records. We assessed incidence, prevalence, and trends in monthly dispensed prescriptions between June 2014 (date of public subsidy) and September 2021. We defined incident users in adults aged ≥18 years as no tapentadol dispensings in the previous year. We assessed characteristics of initiators and patterns of utilization in the year following initiation, including prescription strengths, concurrent dispensing of tapentadol and medicines with known interactions or contraindications, and switching to other opioids. Results4,883,840 prescriptions of tapentadol were dispensed during the study period. Total monthly dispensed prescriptions increased from 2,040 (June 2014) to 91,300 (September 2021). The lowest strength formulations (50mg, 100mg) comprised nearly three quarters of all dispensed prescriptions (3,628,400; 74.3%). We identified 66,334 new episodes of tapentadol use. Incidence rose from 0.8/1000 population in 2014 to a high of 8.4/1000 in 2019, dropping to 5.5/1000 in 2020. Most people initiating tapentadol were aged 45-84 years (48,464; 73.1%) and female (37,709; 56.9%). More than half (38,157; 57.5%) did not receive a second tapentadol dispensing within 90 days of initiation. 10,868 (16.4%) were dispensed a non-opioid medicine with known interaction on the same day as initiation, and 23,205 (35.0%) were concurrently dispensed tapentadol and other opioids. ConclusionThe only approved subsidized indication is tapentadol SR for chronic pain. However, the very high prevalence of single dispensings of tapentadol SR suggests it may be being used off-label for acute pain instead of tapentadol immediate-release; this would be less safe, less effective and also against Australian therapeutic guidelines.

Drugs associated with cataract formation represent an unmet need in cataract research.

Decreased light transmittance through the ocular lens, termed cataract, is a leading cause of low vision and blindness worldwide. Cataract causes significantly decreased quality of life, particularly in the elderly. Environmental risk factors, including aging, UV exposure, diabetes, smoking and some prescription drugs, are all contributors to cataract formation. In particular, drug-induced cataract represents a poorly-addressed source of cataract. To better understand the potential impact of prescription drugs on cataract, we analyzed publicly-available drug prescriptions data from the Australian Pharmaceutical Benefits Scheme. The data was analyzed for the 5-year period from July 2014 to June 2019. Analyses included the number of prescriptions for each drug, as well as the associated government and total prescription costs. The drugs chosen for analysis belonged to any of four broad categories—those with known, probable, possible or uncertain association with cataract in patients. The analyses revealed high prescription rates and costs for drugs in the Known category (e.g., steroids) and Possible category (e.g., psychotropic drugs). Collectively, these data provide valuable insights into specific prescription drugs that likely contribute to the increasing annual burden of new cataract cases. These data highlight the need—as well as new, stem cell-based opportunities—to elucidate molecular mechanisms of drug-induced cataract formation.

Is non-occupational HIV Post Exposure Prophylaxis (nPEP) still used? An exploration of nPEP use since widespread availability of HIV PrEP.

Non-occupational Post-Exposure Prophylaxis (nPEP) is an effective HIV prevention strategy in gay and bisexual men (GBM) taken after possible exposure. HIV Pre-Exposure Prophylaxis (PrEP) is also a highly effective HIV prevention strategy. A retrospective audit of medical records of GBM presenting to a sexual health centre and provided with nPEP compared two periods to determine if nPEP usage changed following availability of PrEP. In the first period (P1) PrEP was available through extended trials. In the second period (P2) PrEP became more accessible through the Australian Pharmaceutical Benefits Scheme (PBS). Period comparisons were performed using a two-population test of proportions with one-tailed testing and significance set at P < .05 using SPSS Statistics Version 25. There were 232 GBM provided with nPEP in P1, and 202 in P2. A two-population test of proportions demonstrated that GBM presentations for nPEP decreased significantly from 302/4779 (6.3%) of GBM visits in P1 to 221/7205 (3.1%) in P2 when PrEP was more accessible (Z=8.53, P < .001). PrEP uptake after presenting for nPEP increased from 30 (12.9%) of total GBM visits in P1 to 69 (34.2%) in P2 (Z=5.26, p < .001). GBM accessing nPEP decreased with statistical significance post introduction of PBS PrEP.

HPR35 The Impact of Biosimilar Trastuzumab on Drug Spending in Australia

Breast cancer is the most common cancer affecting women in Australia with an estimated 20,000 cases diagnosed in 2021. Trastuzumab is the used for the treatment of HER-2 positive breast cancer. It lost exclusivity in 2019 and within a year five biosimilars were reimbursed through the Australian Pharmaceutical Benefits Scheme. Pharmaceuticals in Australia are subject to an initial statutory price decrease followed by an ongoing review of the price through a process called price disclosure. This study sought to investigate the uptake rate, price evolution and budget impact of the reimbursement of trastuzumab biosimilars in Australia.

Persistence with urate-lowering therapy in Australia: A longitudinal analysis of allopurinol prescriptions.

Gout is the most common form of inflammatory arthritis in men. Despite the availability of effective urate-lowering therapies (ULT), the management of gout is suboptimal due to poor persistence with ULT. This study examined national prescribing patterns of ULT to determine persistence with allopurinol in Australia. A 10% sample of the Australian Pharmaceutical Benefits Scheme dispensing claims database was used to identify individuals initiated on allopurinol between April 2014 and December 2019. The number of allopurinol scripts dispensed was used to estimate persistence with allopurinol. Persistence was defined as the number of months from initiation until discontinuation (last prescription with no further scripts acquired for a period thereafter). Kaplan-Meier curves were used to examine persistence, while Cox regression analysis was used to examine the influence of gender, concomitant colchicine and age. The largest drop in persistence occurred immediately after initiation, with 34% of patients discontinuing allopurinol 300-mg therapy in the first month. Median persistence with allopurinol 300 mg was 5months (95% confidence interval 4.76-5.24), with around 63% of individuals not persisting with this therapy for more than 12 months. Concomitant prescription of colchicine on the day of allopurinol initiation only occurred in 7% of allopurinol initiations. No increase in persistence was observed for those co-prescribed colchicine. Persistence with allopurinol was poor. More effective methods targeting prescribers, patients and systems are required to promote persistence with allopurinol. Improving persistence to allopurinol is an important public health goal given the proven potential of this medication to eliminate gout.

Patterns and Predictors of Outpatient Antibiotic Dispensation Following Total Hip and Knee Arthroplasty.

This study aimed to evaluate the month-to-month prevalence of antibiotic dispensation in the 12 months before and after total knee arthroplasty (TKA) and total hip arthroplasty (THA) and to identify factors associated with antibiotic dispensation in the month immediately following the surgical procedure. In total, 4,115 THAs and TKAs performed between April 2013 and June 2019 from a state-wide arthroplasty referral center were analyzed. A cross-sectional study used data from an institutional arthroplasty registry, which was linked probabilistically to administrative dispensing data from the Australian Pharmaceutical Benefits Scheme. Multivariable logistic regression was carried out to identify patient and surgical risk factors for oral antibiotic dispensation. Oral antibiotics were dispensed in 18.3% of patients following primary TKA and 12.0% of patients following THA in the 30 days following discharge. During the year after discharge, 66.7% of TKA patients and 58.2% of THA patients were dispensed an antibiotic at some point. Patients with poor preoperative health status were more likely to have antibiotics dispensed in the month following THA or TKA. Older age, undergoing TKA rather than THA, obesity, inflammatory arthritis, and experiencing an in-hospital wound-related or other infectious complications were associated with increased antibiotic dispensation in the 30 days following discharge. A high rate of antibiotic dispensation in the 30 days following THA and TKA has been observed. Although resource constraints may limit routine wound review for all patients by a surgeon, a select cohort may benefit from timely specialist review postoperatively. Several risk factors identified in this study may aid in identifying appropriate candidates for such changes to follow-up care.

Trends in Systemic Antifungal Use in Australia, 2005–2016: a Time-Series Analysis

Data on antifungal utilization trends are important for encouraging antifungal stewardship. This study explored the use of antifungal agents for systemic application and the impact of reimbursement policy changes in Australia. We analyzed national data from the Australian Pharmaceutical Benefits Scheme (PBS) (2005-2016) and determined patterns of use over time and the impact of reimbursement decisions using an interrupted time-series model. From 2005-2016, there was an increase in the use of most antifungals, especially fluconazole, itraconazole, and posaconazole. Ketoconazole was the most commonly dispensed systemic antifungal agent (46.0%) prior to being removed from the PBS list and being replaced by fluconazole (69.8%). The PBS event "Fluconazole and itraconazole restrictions eased" led to the immediate increased use of fluconazole (0.025/1,000 per day), with both the highest rates and numerical increases attributed to obstetricians and gynecologists (1,969%; 1,851 dispensed prescriptions), as well as dermatologists (1,723%; 1,689 dispensed prescriptions) in 2010 and 2016. This is the first Australian national longitudinal estimate of systemic antifungal use. Our findings show an overall increase in the prescription of most antifungals during the investigated period, with reimbursement decisions impacting utilization. These data provide a baseline to inform the development of national antifungal guidelines and policies to encourage more targeted antifungal stewardship.

Liver Disease and Poor Adherence Limit Hepatitis C Cure: A Real-World Australian Treatment Cohort

Background and AimsIn 2016, direct-acting antiviral (DAA) treatment for hepatitis C (HCV) became available through Australia’s universal health care system, with the aim of HCV elimination. We report real-world effectiveness of DAA HCV treatment in Australia from a clinically well-informed cohort, enriched for cirrhosis and prior HCV treatment.Methods3413 patients were recruited from 26 hospital liver clinics across Australia from February 2016 to June 2020. Clinical history and sustained viral response (SVR) were obtained from medical records and data linkage to the Australian Pharmaceutical Benefits Scheme. Factors associated with SVR were assessed by multivariable logistic regression (MVR).ResultsAt recruitment, 32.2% had cirrhosis (72.9% Child Pugh class B/C), and 19.9% were treatment experienced. Of the 2,939 with data, 93.3% confirmed SVR. 137 patients received second-line therapy. Patients with cirrhosis had lower SVR rate (88.4 vs. 95.8%; p < 0.001). On MVR, failure to achieve SVR was associated with Genotype 3 (adj-OR = 0.42, 95%CI 0.29–0.61), male gender (adj-OR = 0.49, 95%CI 0.31–0.77), fair/poor adherence (adj-OR = 0.52, 95%CI 0.28–0.94), cirrhosis (adj-OR = 0.57, 95%CI 0.36–0.88), FIB-4 > 3.25 (adj-OR = 0.52, 95%CI 0.33–0.83) and MELD score ≥ 20 (adj-OR = 0.25, 95%CI 0.08–0.80). Consistent results were seen in cirrhotic sub-analysis.ConclusionsExcellent SVR rates were achieved with DAAs in this real-world cohort of patients with chronic HCV infection. More advanced liver disease and clinician impression of poor adherence were associated with HCV treatment failure. Supports to improve liver fibrosis assessment skills for non-specialist DAA prescribers in the community and to optimize patient adherence are likely to enable more effective pursuit of HCV elimination in Australia.